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After the Match

So You Want to Be an Academic

Cook, Thomas, MD

doi: 10.1097/01.EEM.0000554855.41282.01
After the Match

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The emergency medicine residency program at Stanford posted a wonderful video a few years ago that lampoons the behavior of emergency medicine attendings. It pokes fun at things we say, and does a beautiful job portraying the universal flaws of our behavior. (http://bit.ly/2TzbElV.)

I find it reassuring that my partners and I have the same idiosyncrasies as our California brethren. Despite these common characteristics, a subset of the many residents I have mentored actually want to join the ranks of well-meaning but often comical teaching physicians.

Many residents decide to pursue an academic career while in medical school. Applicants often ask during interviews how we can provide opportunities to teach medical students. I always ask them why they want to go into academics. Do they have a burning desire to be a researcher? Do they enjoy spending incredible amounts of time writing papers and book chapters that only a few people will ever read? Do they want to sit around the ED while residents see all the patients? Do they love creating PowerPoint slides?

Many answers are possible, but the end point is usually that they love the moment when someone they are teaching gets it. The learner grasps the concept they are explaining, and they get a little burst of dopamine. Teachers are searching for that aha moment, that time when they successfully transfer knowledge to someone else. It is one of the key elements for the success of our species and likely the reason we are hardwired to enjoy it so much.

As with nearly everything though, there is a lot more to this than meets the eye. One example is the transformative event that all emergency physicians experience: their first intubation. The first successful intubation is one of the most exhilarating moments of a physician's career even though it is not a technically difficult task. Many other health care professionals perform intubations with a sliver of the education that costs physicians hundreds of thousands of dollars.

When a physician finally reaches the head of the bed with an endotracheal tube in hand, he has invested countless hours of study, taken hundreds of exams, and dealt with stiff competition for medical school and residency. All that work for the momentary pleasure of a job well done that helps a seriously ill patient. Is the experience all we hope?

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Open to Criticism

Academics is a similar experience. Physicians enjoy mentoring less experienced colleagues, but a truly academic career involves more than passing on bits of knowledge in the course of clinical care. Rather, it requires a huge investment of time in developing expertise in a niche of the specialty. This usually means fellowship training and giving up $200,000 of income at a time when you are suffocating from student loan debt. You also must develop an understanding of how to teach adults effectively, be sensitive to generational and cultural differences, develop public speaking skills, and sit on numerous administrative committees.

You also have to open yourself to criticism from the very residents you are dedicating your career to helping. You know those anonymous attending evaluations you have been filling out during residency? In the future, they will be aimed directly at you. Unlike taking a clinical job where you never really know what your colleagues and subordinates think about you, academic physicians are evaluated annually by their residents. Take my word for it, getting negative feedback from an intern is not as easy as you think, and graduating seniors often feel liberated to tell you their pent-up frustrations about working with you. I know attendings who struggle to read their annual evaluations because it hurts their feelings. (Yes, we have feelings.)

Much of what academics do is redundant. Every July the resident complement turns over by a third, and attendings must assimilate the recent medical school graduates into their new life. Fresh interns have no idea how the ED functions. Basic charting, nursing power plays, consulting eccentricities, the endless stream of policy changes, and where to get good coffee need to be explained. This is fun the first few years.

It's great to be the steady hand that calms interns' apprehension when they start residency. But as years go by, you will wonder every July why interns do not seem to know anything. I often hear older faculty members comment on how each new intern class seems to know less and less. This is common as attendings become more and more removed from their own training. They forget how incredibly anxious interns are because they know so little about clinical medicine.

Nevertheless, you will experience an incredible dividend if you can make the long-term commitment to an academic career. Years of working with residents at the bedside enable you to refine your skill at creating aha moments. Residents will not genuflect or thank you profusely, but they will slowly grasp that you are enabling their metamorphosis into professional clinicians.

If you remain patient, they will eventually let you know how deeply they appreciate your efforts. Every year I receive a few cards from residents who graduated three to five years earlier. They typically don't write that much, but the essence of the message is always the same: “Thanks for all you did for me.” There is no greater reward in my professional life than these simple words of appreciation.

Dr. Cookis the program director of the emergency medicine residency at Palmetto Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him atwww.facebook.com/3rdRockUltrasound, follow him on Twitter @3rdRockUS, and read his past columns athttp://bit.ly/EMN-Match.

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