An underground handbook for surviving and thriving on your shifts as an EP

BPP - Oakland 1969

There is a knowledge gap in Emergency Medicine.  It lies within the difference between the way we teach and the way we learn.  Bridging this gap is the EMBER Project’s educational manifesto of sorts.  It starts with the belief that our continuing education as Emergency Physicians should not be an endless continuation of the traditional didactics we’ve become accustomed to in our formal training as physicians. Instead it should be a more complete and thoughtful examination of what makes us successful in our daily EM practice.

Over time we become suffused with a host of accumulated skills, knowledge, wisdom, tools, and relationships, and we develop conscious and unconscious strategies for success in the emergency department. Sadly, most of this knowledge is not recognized by us or even taught to new physicians, and falls into what I like to call the “crash and burn” school of medical education.

Perhaps because we have had to learn much of it by personal experience, we have difficulty recognizing its central importance in our development as good physicians – much less being able to describe how we became proficient in these areas to others. Teaching is a skill.  We learn by watching others.  I learned how to teach ECG interpretation by being taught by someone else, but how do you teach skills that have never been taught to you?

The second tenet of the manifesto is that physician well-being and patient care are inextricable.  Success in Emergency Medicine starts with accepting that our physical and emotional resources are finite, and that the practice of Emergency Medicine is challenging. For generations I believe that publicly acknowledging our limits and the fear that we will be seen as lazy have been conflated in our profession.  The stereotype of the tireless physician and the fall out from this impossible ideal still haunts us.

We have limits, rather than ignore them, we must learn to minimize the impact  of those things which are a drain on us, and maximize the supportive resources we have around us.  Doing this well is part of becoming an efficient practitioner of the EM art, and is essential to longevity and well-being in our profession.

The Smooth Sailing series takes both of these concepts to heart.  It is a re-examination of our development as Emergency Physicians from a personal well-being perspective, in order to define the strategies that help us develop a sustainable career of continued growth, improve how we care for our patients, and getting you home at the end of hard shifts happy and healthy.

I’m excited to begin exploring what makes us successful and healthy emergency physicians in this series.  I hope you find it as useful and interesting as I do, and that you will share your insights and comments with me along the way.  Perhaps in discussing how we acquire these skills they will become part of a more conscious strategy for success that we will be able to pass on and teach to others.  Stay tuned, the first chapter in this series is coming very soon.  In the meantime please check out the last Smooth Sailing post to get an idea of where we’re headed.