Patients will rush to the emergency room wanting treatment for anything from abdominal, back, and chest pains to fevers, bruises, sprains and vaginal discharge among many other things.
Emergency medicine is unique because its practitioners have to be ready to treat any problem at any time of the day, said Dr. Sam Kini, a veteran emergency physician who now teaches and supervises fourth year medical students at the Georgia Regents University-University of Georgia Medical Partnership in Athens, Ga.
“We are a blend of all specialties,” said Kini. “We see patients with all kinds of complaints and we want the students to have that experience of just seeing all patients, all types, all ages, all hours of the day and night,” he said.
In 2010, Medicaid patients made up the majority of emergency room (ER) visits in Georgia, according to data from the Georgia Department of Public Health. The American College of Emergency Physicians (ACEP) released a statement, saying that the organization expects ER visits to increase nationwide with the implementation of the Affordable Care Act.
”Increasing the number of patients on Medicaid without an equivalent increase in the number of physicians willing to take that insurance will surely increase the flood of patients into our nation’s ERs,” former ACEP board president David Seaberg said in the release.
During their fourth and final year of medical school, students have three required, month-long clerkships, also called rotations, to complete in addition to three electives and a sub-internship. Students spend one day each week learning in the classroom and up to four days at hospitals throughout northeast Georgia.
The emergency medicine rotation will be valuable to students regardless of what specialty they choose or where they practice. An emergency can happen in any setting and when patients experience a frightening symptom – such as chest pain or sudden numbness –whether they are in a primary care office or an orthopedic clinic, they expect physicians to know how to react.
Fourth-year medical student Bree Berry, completed her emergency medicine rotation at Eastside Medical Center in Snellville, Ga. She was barely into her second week there when she had an unexpected, yet unforgettable experience.
“On Labor Day I saw a guy who had an accident with his table saw and nearly amputated [all] five of his fingers on his right hand,” Berry said.
Berry plans to go into primary care, so although it is unlikely that she will have to treat such incidents, she recognized how this rotation will be useful to her.
“Since I don’t plan to be working in an emergency room I think it will be valuable for me to know which patients I need to send to the emergency room,” Berry said, “and which I can safely treat in my office.”
Emergency medicine has grown in popularity among graduating medical students. Data from the Association of American Medical Colleges showed that the average of emergency medicine residency applications increased from 28 percent in 2010 to 31 percent in 2011. In 2012, the number increased to 35 percent.
Yet Kini said that only five of his 40 students plan to complete an emergency medicine residency after graduating in 2014.
Patients use the ER for urgent situations but they also misuse it as a replacement for primary care, so ER physicians never really know what to expect from these unscheduled visits.
This surprise element may be frightening for some medical students, but for Xiao Li it is exciting and highly contributable to his growth. He said he enjoyed only knowing a name and age when first entering a patient’s room.
“When it comes to emergency medicine what I like most about it is that you never know who or what’s coming in,” said Li, who completed his clerkship at St. Mary’s Hospital in Athens and plans to specialize in radiology.
At least once a week, Kini visits his students at their rotation site to note their progress and assist ER physicians with teaching. He and the ER physicians teach students to recognize common and serious diseases and order appropriate tests; then they teach them how to determine the correct treatment and decide which patients stay at the hospital and which go home.
When Kini works with a student in the ER, he lets the student take the medical history and perform a physical examination first while he asks questions and then he performs the same tasks on his own. Afterwards the two exchange thoughts and notes outside the patient’s room.
Playing the role of both student and instructor, helps students appreciate what they did right as well as understand what they should have done differently. Kini said getting students to recognize why he asked a question that they didn’t teaches them to learn from their mistakes.
“It gets the student to think, as to why I asked this question [and] why they missed it,” Kini said, “and they won’t miss it in the next room.”