Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? No

摘要

There is no debate over the need for medical student's education. Universities carefully design their curriculum with the aim to produce well-rounded interns with knowledge across all the major medical and surgical specialties. Students receive formal and informal training from a variety of sources during their university degree. While on rotation in hospitals, students spend time with university-assigned tutors, and attend lectures and workshops. They have clinical contact with patients supervised by professionals from across many specialties. This contact takes place on the wards, in operating theatres, in outpatient clinics and also in the ED. This real patient contact allows students the opportunity to put their new skills into practice. It is essential for patient safety that medical degrees equip junior doctors to deal with undifferentiated patients. They need to be able to employ patient assessment skills, perform simple procedures1 and be competent in developing basic management plans. The ED is the perfect venue for this learning to take place. The breadth and variety of educational opportunities that present themselves are rarely encountered in other ambulatory or inpatient settings.1-3 Within the ED, there is a broad range of staff. Medical, nursing and allied health staff of varying levels of experience and expertise work alongside one another. All of us are able to contribute to medical student education in different ways. We could decide that we, emergency registrars, are too busy to be involved. The 200–300 undifferentiated patients who present to tertiary EDs every day are where our energy should be focused. We should just get on seeing patients and concentrate on our own training. Leave it up to the university. Leave it up to the other specialties. Leave it up to our consultants; it should be their responsibility. If this is how we feel, we might as well be robots on the conveyor belt of the ED, churning through patients who are then being methodically sorted into disposition piles, the quicker the better. Is this really the direction we want our specialty to head? We have a choice – to be seen by the healthcare system simply as service providers or as professionals with a wealth of knowledge and skills to benefit our patients; knowledge that we can pass on to our students so that they have a solid foundation on which to build their clinical expertise. I would argue that the emergency registrar, with broad-based knowledge and experience,1 has much to offer students. From the perspective of prevocational doctors, registrars have been considered the most highly valued sources of education, significantly more than consultants.4 While we are busily absorbed in the day-to-day function of the department and still in training ourselves, we are bubbling with new skills and up-to-date knowledge; knowledge that will be consolidated and enhanced by educating the next generation of doctors. Interns will be required to manage ward emergencies from their first day at work.5 Therefore, they need to acquire these skills in a supervised environment during their undergraduate training. We are perfectly placed to assist medical graduates to develop an approach to life-threatening conditions. In the ED, there are countless opportunities for students to observe professionals and participate in dealing with critically ill patients; something they might not see elsewhere in the health system. The modelling provided by more experienced clinicians is a most powerful educational approach. The increasing pressures in the ED are well recognised. Across Australia, there are an approximate 7.2 million presentations per year, with a 4.6% annual growth rate.6 Obviously, not all registrars will embrace teaching, and with the current pressures of overcrowding, key performance indicators and National Emergency Access Targets, teaching might at times seem overly burdensome. I would urge all EDs to see the value in teaching. Teaching requires exp