Templates are useful if most of your dictations more or less follow the same pattern (e.g. in my case, dictating a CT brain as a radiology resident), but not so useful when you're describing a highly variable clinical course for a patient. It's useful to just know the general outline of the report (i.e. Diagnosis, Medications, Hospital Course, Follow-up Plans, etc.), and your knowledge of how to be concise and what needs to be included will develop with practice. Also, as an ED resident, you will no doubt encounter bounce-back patients who return to the ED after being discharged from the hospital or ED recently. Pay attention to the discharge summary that was written for these patients, and tell yourself: Is this written well enough for me to pick up from here and take care of the patient?

The most important element to remember about the dictation is that it has two main roles:

1) To provide hand-off information to any healthcare provider who may need to pick up where you left off with the patient. The healthcare provider will need to know such details as what kind of imaging studies or surgery/procedures were performed, what medications the patient was instructed to take on discharge, etc. It's also important, and something I see a lot of discharge dictations skip, to at least briefly mention the reasoning behind any less-than-completely-conventional medical decisions you make. Don't bog down the reader with details, though: The busy doctor who will pick up your patient as an outpatient doesn't want to read a thousand-word essay but just wants the essentials that will help him take care of the patient. The follow-up section of the dictation is particularly important for this.

2) Medico-legal reasons. I won't go into depth on this, but the medical decision-making reasoning I mentioned in the previous point can play a big role here.

Your primary goal in doing a dictation is to tell a concise story that informs the healthcare provider but doesn't frustrate them.