PA Emergency Medicine Rotation: Skills & What to Expect
PA Emergency Medicine Rotation: Skills & What to Expect
By: Savanna Perry, PA-C
An emergency medicine rotation is one of the most hands-on months of your PA clinical year. You will see a huge range of cases and get to practice real procedures like suturing, lumbar punctures, and reductions, so the best approach is to say yes whenever you feel comfortable and jump in.
Last Updated: June 12, 2026
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How does a PA emergency medicine rotation work?
Going into my emergency medicine rotation, I was a little apprehensive, because anything can walk through those doors. I was at a smaller hospital where there were usually 2-3 physicians and 2-3 PAs or NPs on at any given time. My preceptor loved to teach, and if we had downtime he would squeeze in a quick lesson on an essential ER topic.
The flow is straightforward once you see it. A patient signs in and gets triaged, and their name and chief complaint pop up on the provider's computer. Each MD or PA then decides who they will pick up, balancing simple cases like a cut that needs sutures with more complex ones that need labs or imaging. My preceptor would usually grab two cases at a time, so I would go see one patient while he saw the other.
What skills can you practice in the ED?
Working in the ER is a fantastic chance to see a lot and practice a lot, and it is not the time to be shy. If they give you a chance to do something and you feel comfortable, go for it. Here are some of the skills I got to practice or watch during this rotation:
- Suturing a laceration (I closed a chainsaw cut on my own)
- Lumbar puncture (I watched one on a newborn and practiced on an adult)
- Central line placement, with my preceptor guiding me through the femoral approach
- Intraosseous IV, which you place at a 90 degree angle
- Removing a fishing hook from a patient's neck
- Watching CPR and a mechanical chest compression device in action
- Stapling a scalp laceration on a child
- Draining a cyst (great practice for my current derm job)
- Reducing a dislocated shoulder, which honestly went smoother than I expected
Not everything goes perfectly. When I was asked to set a child's broken arm, I almost passed out and had to run out of the room to sit down. Bones are just not my thing, and that is okay. You learn what you love and what you do not.
In our experience coaching pre-PAs and PA students, emergency medicine is where the timid students grow the fastest. The ones who say yes to procedures, ask to be called for anything interesting, and stay a little late on busy nights walk away with skills and confidence that carry into every future rotation.
Is emergency medicine a good fit for you?
By the end of my ER rotation, besides the bone stuff, I really felt like I could enjoy working in that field. I loved the hospital and the people, and it would be a wonderful place to work. The ED is unpredictable, so you get some slow days and some days so busy that patients are being treated in the waiting room.
You will also see drug seekers, difficult patients, and folks who really just need prompt care, but that is all part of medicine, so you handle it. The one thing I did not love was the long shifts. Twelve hour shifts a few days in a row left me feeling like I just worked, ate, slept, and repeated. It is exhausting at first, but I think you would get used to it if you did it all the time.
Every Pre-PA Should Know...
ER shifts often run 12 hours, and the pace can swing from quiet to overflowing within the same shift, so pacing your energy matters as much as your clinical knowledge.
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Listen: Day in the Life: Nocturnal ER PA Brian Palm (Part 1)
Happy PA Week. Let's spend it in the ER at 3 a.m.
Happy PA Week. Let's spend it in the ER at 3 a.m.
Brian Palm works nights in emergency medicine, and for PA Week I wanted to give you a look at a schedule most people never see. Part one of our conversation covers what nocturnal ER work is really like.
Nights are a different job than days. The volume shifts, the case mix shifts, and you have fewer people around to consult. Brian talks about the range of what comes through the door, how you make fast decisions with incomplete information, and how you stay sharp when your body thinks it should be asleep.
We also get into the tension every ER provider feels between moving patients through and giving each one the care they deserve.
What we cover
What a nocturnal ER shift actually looks like
How night shift differs from working days
The range of cases that come through overnight
Making quick decisions under pressure
Balancing throughput with thorough patient care
How Brian ended up in emergency medicine
Resources
Follow The Pre-PA Club: Apple Podcasts · Spotify · All episodes
Listen: Day in the Life: Nocturnal ER PA Brian Palm (Part 2)
Part two with Brian: autonomy, physicians, and having a life.
Part two with Brian: autonomy, physicians, and having a life.
We pick up where part one left off. This time Brian Palm gets into how much independence he actually has in the emergency department and what the working relationship with his supervising physicians looks like day to day.
That question comes up constantly from pre-PAs who are worried they'll be looking over their shoulder for permission on everything. The real answer is more nuanced and depends heavily on your experience, your department, and the physicians you work with.
We also talk about the pandemic's effect on emergency medicine, and the ongoing project of keeping a personal life intact while working nights in a demanding job.
What we cover
Autonomy and independence for PAs in the ED
How the collaboration with supervising physicians works
Emergency medicine during the pandemic
Protecting family time around a night shift schedule
What sustains a long career in emergency medicine
Advice for pre-PAs interested in the ER
Resources
Follow The Pre-PA Club: Apple Podcasts · Spotify · All episodes
Need to Know:
Emergency medicine is one of the most procedure-heavy rotations in PA school
Patients are triaged and providers pick up cases, balancing simple and complex
Say yes to hands-on skills whenever you feel comfortable and supervised
You will see a wide range, from lacerations to codes to reductions
Shifts are typically 12 hours and the volume is unpredictable
It is a great place to discover what you do and do not enjoy clinically
FAQ
Under supervision and when you feel comfortable, you may suture lacerations, assist with lumbar punctures and central lines, place intraosseous IVs, drain cysts, and help with reductions, depending on your preceptor and site.
ER shifts are commonly 12 hours, and you may work several in a row, which can feel exhausting until you adjust to the rhythm.
Yes. Emergency medicine is one of the best rotations for procedures and exposure to a wide variety of cases, so it builds real skills quickly.
Patients sign in and are triaged, their chief complaint appears on the provider board, and each MD or PA picks up cases, usually balancing simple and complex patients.
It happens to everyone at some point. Step away, sit down if you need to, and do not be hard on yourself. It is part of learning what specialties fit you.
Be proactive, not reckless. Ask to be called for interesting cases and volunteer for skills you feel ready for, but always stay within your comfort and your preceptor's guidance.
CLOSING
Emergency medicine pushes you to think fast, use your hands, and get comfortable with the unexpected, which makes it one of the most formative months of your clinical year. Lean in, ask to be involved, and you will surprise yourself. If you want a game plan for getting the most out of your clinical rotations, we would love to help.
New Graduate Coaching → https://www.thepaplatform.com/new-graduate-coaching/
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