TRAINED BY THE BEST, PREPARED FOR THE WORST
With their unique structures and tried-and-true training procedures, the UMKC emergency medicine residency and education programs prepare the next generation of physicians for any scenario
By ZOE WU
25It was an unseasonably warm February morning. Fans in Kansas City Chiefs red congregated around Union Station, the post-victory parade rally spot for celebrating the world-champion team. As the rally ended, thousands crowded around, hoping to get one last glimpse of their favorite football players.
As confetti fell, loud pops rang in the air. Shouts and screams erupted. Police officers rushed parade goers away from the scene. A tragedy unfolded on live television, and the community soon learned several people – including children – had been shot, and one person killed.
Immediately, emergency responders rushed into the chaos. University Health and Children’s Mercy Kansas City staff – including UMKC emergency medicine faculty, residents and fellows – provided medical care both on site and back at the hospitals to those who were injured.
Despite the fear, sadness and confusion that day, the residents responding were all able to work swiftly, efficiently and calmly, thanks in large part to the education they receive at UMKC. The rigorous emergency medicine residency training – along with the emergency response preparation all its medical students receive – are critical pillars of the curriculum at the School of Medicine.
Preparation is Key Mark Steele (B.A./M.D. ’80), associate dean and chief clinical officer at University Health, said while mass-casualty situations are never expected, emergency medicine physicians are always prepared for them.
“There are different policies and procedures written and reviewed on a regular basis,” Steele said. “There are community-wide disaster drills we take part in. It’s the repetition of the mechanics that gets us prepared.”
To reach that level of preparation, doctors must train and practice for years – and all UMKC School of Medicine students have some degree of emergency training, no matter what specialty they pursue. Every student must complete an emergency medicine clerkship in their fifth or sixth year, which Steele said isn’t common at most other medical schools.
“We know when UMKC students, residents and fellows leave us, they have a solid foundation in pediatrics that allows them to take care of kids and to provide high-quality pediatric care – no matter where they are.”
— Jennifer Watts, M.D., MPH
Melanie Camejo (BLA ’13/M.D. ’14) is the school’s emergency medicine clerkship director. She is also an associate professor, associate fellowship director and associate emergency residency director at the school, as well as an emergency medicine physician at University Health.
“We do disaster drills and simulations in the trauma bay at a moment’s notice, have weekly didactics (or workshops) that cover emergency topics and have monthly simulation didactics,” Camejo explained.
During these simulations, students and residents are assigned roles they might have in a real-life hospital setting. An ED attending follows along with a script and controls a manikin “patient,” which mimics a human’s real reactions. The “patient” can either stay alive or code – depending on which actions the students decide to take in the moment. This makes the scenario as real as possible – without an actual life at stake. Once the simulation is complete, the group debriefs and everyone has an opportunity to give feedback.
“There are a lot of benefits to being the only training program for pediatrics in our city – and really in our region,” Watts said. “We know when UMKC students, residents and fellows leave us, they have a solid foundation in pediatrics that allows them to take care of kids and to provide high-quality pediatric care – no matter where they are.”
Mark Steele (B.A./M.D. ’80), chief clinical officer at University Health, gives a briefing to media following the shooting at the Chiefs rally in February. Photo courtesy of University Health.
Prof. Melanie Camejo (BLA ’13/M.D. ’14) discusses a patient's case with a medical student during an early morning shift in July.
The Heart of Kansas City Unlike other peer institutions, UMKC has affiliations with seven hospitals that allow UMKC medical students and residents to train more effectively. The affiliate hospitals provide students with multiple specialties to choose from, specialized equipment to work with and a large variety of patients and cases to see. This is beneficial for all students and residents, but especially for residents in the emergency medicine program.
Emily Hillman (BLA ’07/M.D. ’08), the school’s emergency medicine residency program director, said one of the university’s best attributes is its location within the city.
According to Camejo, because of the large influx of patients at hospitals like University Health, UMKC students and residents who train there also get more of an opportunity to practice being quick on their feet.
“You don’t have time to prepare for a stressful situation in the emergency department,” Camejo said. “They happen in seconds with no warning, so every shift you go in knowing that anything can happen. Most of us do our best thinking in high-stress situations.”
Dustin Neel, M.D., associate professor at the UMKC School of Medicine and trauma medical director at University Health, believes practicing inside an emergency room in downtown Kansas City prepares students for anything once they graduate.
“It is already uncommon to have a trauma department, but University Health is a Level 1 trauma center,” Neel said. “That, plus our location and population, allows for a great variety of pathologies of various diseases people just don’t see very often, which allows the medical students to get comfortable seeing things they might only see once in their career.”
Jennifer Watts, M.D., MPH, is a professor at UMKC and pediatric emergency medicine physician at Children’s Mercy. Instead of a lecture hall, Watts does most of her teaching in the hospital – the only place medical students in Kansas City can train in pediatrics.
“There are a lot of benefits to being the only training program for pediatrics in our city – and really in our region,” Watts said. “We know when UMKC students, residents and fellows leave us, they have a solid foundation in pediatrics that allows them to take care of kids and to provide high-quality pediatric care – no matter where they are.”
Top: Prof. Jennifer Watts, M.D., does most of her teaching inside Children's Mercy Kansas City. Bottom: Medical students Taylor Lynch and Daniel Terry practice their intubation skills as part of their emergency medicine training.
Six-Year Program Sets Students Apart The unrivaled emergency medicine curriculum at UMKC isn’t something that developed overnight. Adam Algren (B.A./M.D. ’01), chair of UMKC’s emergency medicine program, said UMKC’s program was one of the first of its kind in the country, and added that the program’s longevity is one reason acceptance letters are so sought after.
“We have a lot of history and tradition,” Algren said. “We’ve trained more than 400 emergency physicians who have gone out and practiced throughout the country, and we have quite a few alumni who have served in various leadership roles.”
The unique six-year B.A./M.D. program at UMKC also allows students to get more hands-on experience than at a typical four-year medical school. That extra experience makes a big difference in the emergency room – and mentors notice.
“I work with residents from many different programs,” Watts said. “The UMKC graduates have all been extremely well prepared to handle any emergency. They come with such a great foundation that it makes our job easier.”
Scott McCulloch (B.A./M.D. ’89) is a retired emergency medicine doctor who completed his residency with UMKC at University Health. He felt much more prepared than his fellow residents because the program at UMKC provided him with experiences they didn’t have.
“I think having interaction with patients since the age of 18 is something that can’t be compared or exchanged,” McCulloch said. “I remember when I started my residency, there were residents from other programs, and they were always so surprised with how seasoned and comfortable we were around patients. We were already ahead of the game.”
Meaningful Mentorships The UMKC emergency program also has deeply committed faculty and staff. Alexander Garza, M.D. (B.S. ’90) received his undergraduate degree at UMKC and came back to complete an emergency medicine residency. In 2009, appointed by President Barack Obama, Garza served as assistant secretary for health affairs and as chief medical officer for the U.S. Department of Homeland Security. Today, he is chief community health officer at SSM Health in St. Louis.
Garza said what he remembers most about his time at UMKC is the dedication of the faculty.
“I think what set UMKC apart were the staff and instructors that I had,” Garza said. “They were truly vested in the mission, from the way they took care of patients in the emergency department to the care they delivered.”
McCulloch shared a touching story about one of his mentors.
“I’ll never forget our exit interview when we were finishing residency,” McCulloch said, with tears in his eyes. “At the time, Mark Steele was our residency director. He told me from that point forward, I am always going to be considered a peer and not just a mentee. I always get choked up because it means so much to me, even all these years later.” n
Emergency Care Takes Toll on Mental Health
By RACHEL DEYOUNG
IN ADDITION to being prepared during emergency events, the School of Medicine and its affiliates are also prepared for what's needed after a tragedy occurs. Mental health support for students, residents, faculty and staff is crucial, especially for those in the emergency department. Anywhere from 11.9% to 21.5% of emergency medicine residents meet the diagnostic criteria for post-traumatic stress disorder (PTSD), according to the Annals of Emergency Medicine journal.
While PTSD is most commonly associated with military combat, it’s also common among frontline healthcare workers. PTSD is different from stress or burnout, because while those states tend to be short-lived and can often be eased independently, symptoms of PTSD can worsen over time, often requiring those suffering from the disorder to seek psychological intervention.
Emergency medicine physicians see various degrees of illness, trauma, violence and even death in their work on a daily basis – exposure to all of which can cause a person to develop PTSD.
These concerns are top of mind for faculty at UMKC and the school's affiliates. Jennifer Watts, M.D., MPH, professor and physician at Children's Mercy, said mental healthcare was of prime concern on the day of the parade shooting. Children’s Mercy deployed members from its Center for Wellbeing, a department focused on a number of initiatives that include support for distressed staff, residents and fellows, crisis intervention and referrals for mental health and other support services.
“They did a debriefing with us right after the incident so we could start to process everything we just faced once all the critical care was done,” Watts said.
With a fast-paced and stressful job like emergency care, physicians often don’t have a lot of time to think about their own mental processing – especially when a life is on the line. This makes it all the more important for everyone on the care team to prioritize checking in with each other.
“Some of (the processing) occurs immediately, some of it occurs in the weeks following and some occurs in the months to years following,” said Watts. “We make sure everyone is getting the support they need.”
A recent study in the Journal of Patient Safety states more than two-thirds of providers involved in an adverse clinical event suffered from troubling memories, anxiety, anger, remorse and distress in the days following. These feelings are something UMKC and its affiliates made sure to address in the aftermath of that tragic day in February.
“As emergency medicine physicians, we tend to be really resilient and have a lot of grit,” said Emily Hillman (BLA ’07/M.D. ’08), UMKC’s emergency medicine residency program director. “It allows us to respond appropriately during a crisis, but we end up not taking care of ourselves a lot, which is why we made sure to take care of the psychological safety of our residents right after (the shooting).
“One thing I'm really proud of is how UMKC and University Health both really rallied to make numerous options for mental healthcare available and accessible. It means so much, especially for the residents.”