Teaching medical students emergency medicine

Introduction

Emergency medicine now plays a central role in medical curricula in undergraduate and postgraduate medical schools in Australia and New Zealand. This is expected, as the principles and practice of the specialty have much in common with the desired features of contemporary medical education: it is problem focused, interdisciplinary and integrates many aspects of community-based and hospital-based clinical practice. The clinical practice of emergency medicine integrates and builds upon the foundation biomedical sciences. Much growth in academic emergency medicine has occurred in the last two decades, with the establishment of academic departments and salaried university positions. Nevertheless, the majority of medical student teaching is performed ‘pro-bono’ by clinical emergency physicians employed by public and an increasing number of private emergency departments. Put simply, emergency medicine has become a key part of academia, and academia has become a key part of emergency medicine.

Regardless of institutional affiliation or employment, it is essential for emergency physicians committed to teaching medical students to be aware of recent trends and developments in medical education. Medical education as a discipline is vast, and it is not the purpose of this chapter to delve into the many intricacies and emerging themes of medical education as a whole. As an example, in 2010 the US-based Carnegie Foundation (which published the landmark Flexner Report in 1910) published a comprehensive review of contemporary physician education and identified the need for reform in medical education. The authors called for greater alignment between educational institutions and the workforce, and the requirement for medical schools to produce graduates more responsive to society’s health care needs in the 21st century. These reforms are necessary and timely, and while emergency medicine does not specifically feature in the report, most emergency physicians would see a significant role for the specialty in delivering them. In Australia, some curriculum reform has occurred in parallel with significant changes in the health system. The shift to the home and community management of many conditions has altered the ‘traditional’ patient mix and numbers available for student teaching. At the same time, there has been an increasing number of medical students and medical schools, with 3853 domestic and international students commencing medical training in Australia in 2017. It is in this changing environment that emergency medicine, with 7.8 million patients presenting to 287 public emergency departments in the 12 months of 2016 to 2017, has established itself as a both a desirable and necessary part of the modern medical curriculum, and the specialty is poised to play an even greater role in the training of future doctors. Both the need and the opportunity exist for such expansion.

The importance of medical student teaching

Many departmental directors and clinicians feel that the provision of clinical care is the core business of an emergency department and hence may not be willing to allocate increasingly stretched resources and time for teaching students. Similarly, the ‘old school’ leadership teams at medical schools may not be aware of the growth of emergency medicine as a specialty and hence not aware of what it can offer students or, indeed, may not even be aware that emergency medicine is an independent specialty with its own unique body of knowledge. However, once established, a strong academic presence can contribute to departmental morale, recruitment and retention of staff, quality of care, performance, and the standing of the department within the hospital and community. For students, a positive exposure to a specialty in medical school has been shown to influence career choice and attitudes towards specialties. Box 27.4.1 lists the benefits of emergency medicine teaching to students, emergency departments (EDs) and medical schools. These points may be used to argue for an increased presence and accompanying resources within a department, hospital or university curriculum. Resources and a formal place in the curriculum often come only after years of hard work in establishing the bona fides of emergency medicine. This may require much time and effort from a dedicated individual before sustainable resources will be allocated to emergency medicine as a discipline.