Essentials of a Teaching ED

#medstories #intraining

When I was on the residency interview trail, I made it a point to make every conversation an interesting one. After all, the interview trail was the single biggest opportunity I would have to pique the brains of Emergency Medicine (EM) faculty and leaders from around the country. For me, the “do you have any questions for me?” segment at the end of every interview was an opportunity to learn just a bit more about my field through the eyes of a person who lived it every day. Sometimes I asked about ultrasound, other times, the impact of politically targeted legislation like the ACA on Emergency Departments (ED).

Most commonly, I recall asking about what makes an EM residency program: What three components are most important in creating a well-functioning teaching Emergency Department with a great learning experience for residents. Nearly every program agreed that the most important component was great pathology — EM residents thrive on caring for sick patients and learning how to handle anything that comes into their ED. Beyond that, the list diversified into a series of elements that are all probably important in creating a great teaching ED:

  • Faculty in several subspecialties
  • Academic exposure to subspecialties
  • The latest and greatest in electronic patient care devices
  • High patient volumes
  • Nurses and techs who drive patient flow
  • Strong relationships with admitting medical and surgical teams
  • ED participation in hospital committees
  • Formal feedback opportunities
  • Resident wellness
  • Resources for resident research
  • Attending physicians who love to teach

While just a month of residency training is certainly not enough to know which of these components are most important, it is enough to form an opinion about the matter.

Certainly, pathology has proven to be the most important component of training. Even as a first-year resident, I am acutely aware that my patient evaluations and keystrokes on electronic patient charts matter. And, I know that they will matter more with every passing year. To be able to see a wide range of pathology in so many different stages of illness is absolutely fundamental to developing the clinical acumen necessary to independently treat patients in the future. That’s precisely why county hospitals are such incredible training sites for EM and Ben Taub Hospital, where I train, is no exception. Beyond our primary site of training, rotating at other fantastic institutions within the Texas Medical Center (TMC), including Texas Children’s Hospital and MD Anderson Cancer Center, gives Baylor EM residents an opportunity early on in our careers to see patients with a wide range of care needs.

Texas Medical Center (Aerial View), Source: Luxurway

The second most important component, I believe, is resident access to resources in their area of interest or niche. For some, this means having academic exposure to a particular subspecialty. For me, it means having an opportunity to practice and learn at TMC, and work with Baylor faculty involved in different institutions across perhaps the largest medical center in the country. The attending physicians I have had the pleasure of working with span from those who work on Health Policy at a city and state level to those who work in Innovation at TMC. Their wealth of knowledge and practical experience go well beyond what I could hope to learn in the next three years, but the fact that I can grab a coffee with them to learn more about the projects they are involved in and get involved myself is an asset to my development as a physician leader.

The third most important component I’ve found is a continuing focus on resident wellness. This spans beyond resident appreciation days and results from a conscientious effort to facilitate learning and wellness in an environment that is inherently challenging. Residency is difficult — as a program director once put it, “It’s not Disneyland.” Hours can be long and meals can be sparse, but every medical student that I know has jumped into the challenge with this single-minded and voracious appetite to learn how to care for others. We make the sacrifices necessary so that we can get better and do better for our patients.

Having approachable faculty that are sensitive to our needs as residents helps us learn and shape our future practice, guiding us along the road of residency rather than letting us wander that path alone. Offering opportunities for resident bonding across and within classes creates a resilient “band of brothers” to roam with and turn to when the terrain gets rough. A program that considers resident well-being on a daily basis is like a parent who calls their child to check on whether they had a meal that day: it ensures that residents have someone caring for them when they’re simply too busy to care for themselves.

I feel blessed to have an opportunity to become the best physician I can be at Baylor Medical College. Every day is filled with new surprises and patients I can’t wait to help, and it is a fulfilling experience to walk into the ED and never feel the time pass while on a clinical shift. It is surreal to spend those shifts working with the very attending physicians I hoped I would one day have an opportunity to meet in my career — the mentors who I expect will be an integral part of my journey during residency. And it is a pleasure to work with senior residents and faculty who I know care about my well-being as a person in addition to my performance as a resident. I am forever grateful to our program’s leadership for creating such an incredible experience and giving me an opportunity to be a part of it. Thank you!

Pavitra P. Krishnamani is an EM resident physician with a background in global health interested in innovating how we deliver healthcare to our patients at home and abroad. To learn more about her and her work, check out her website.

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