American Academy of Emergency Medicine

Academics for the Community Based Emergency Group

I work for an independent democratic group in the mountain states. Our city has relied on physicians coming to practice from other places as there is currently no formal training program in the city. To this end, the city is embarking on a progressive program in medical education that includes a branch campus of the university medical school. As this program develops, there is currently a drive for recruiting physicians practicing in the community to participate in the clinical education of medical students. This developing program has created two questions for me. Whose duty is medical education? How can a program function to the benefit of the community-based practicing emergency physician and the medical student?

The concept of emergency medical education in the community is not a new one. There are many benefits to participating in medical education in a community setting. For the students, most physicians practice in a community settings for most of their careers. What better setting to prepare for their future careers than in a busy community practice? The community setting has different resources and challenges for emergency physicians. Students can see first-hand how these interactions play out no matter what specialty they eventually pursue. Community physicians, on the other hand, have the opportunity to participate in positive learning experiences for students that will eventually shape how future colleagues perceive, appreciate or dismiss the practice of emergency medicine and their interactions with it in the future. As many physicians eventually practice in the area where they trained or went to medical school, physicians that participate in medical education may see the fruit of their labor in future colleagues practicing in their community within their career.

The challenge for the community-based emergency physician is teaching when time is a scarce resource. Our time is consumed with documentation and order entry in electronic medical records, meeting performance-based metrics and downward trending reimbursements that force us to see more patients in less time to stay afloat. Time for medical education competes with financial incentives in productivitybased reimbursement model. Many physicians will lose interest when education affects the bottom line at the end of a shift.
Can education and productivity find a happy balance in a busy community emergency department? What are the successful models for democratic groups to implement a medical education program that is fair to all practicing physicians? Is it fair to ask some physicians to contribute financially to balance the productivity of those physicians whose time is consumed with education? Editor and readers, I need your help in this regard.

 — Respectfully,
Robert Lam, MD FAAEM

Thank you for writing. I hope our readers can answer your questions and give you sound advice on making this new program work, because I cannot. I do believe all physicians have an ethical duty to further medical education when they have the opportunity, and having taught medical students myself I understand how they can reduce flow through an ED. However, now that the EMR/EHR has taken hold and slowed patient flow more than any gang of medical students ever could, perhaps medical students might improve flow by acting as scribes rather than just standing and watching you perform an H&P? Whether entering data, collecting test results, or keeping patients informed, surely medical students can be made useful enough to offset the time it takes to teach them. And they are bound to improve customer satisfaction scores. Medical students may not have the entirely negative impact on an emergency physician’s bottom line that you anticipate. I am confident that you will find a way to make this program work. Perhaps such programs will help lure graduating emergency medicine residents out of big cities and major trauma centers and into smaller communities and rural areas, where they are so desperately needed. I hope you will eventually write back, whether in a letter to the editor or a full-size article, and let us know how the program turned out and what you learned along the way. In the meantime: readers, Dr. Lam needs your help and advice! Either contact him directly or reply with your own letter to the editor.

— The Editor

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