Leaders in Medical Education

Dr. James Jones, Former President of the American Board of Emergency Medicine

Thasin Jaigirdar
Apr 13, 2015

Dr. James Jones is a Professor of Clinical Emergency Medicine at Indiana University. He graduated from DePauw University and received his MD from Ohio State University’s School of Medicine. He subsequently completed his residency in Emergency Medicine at Wright State University. He serves as a member of the Board of Directors for the American Board of Emergency Medicine where he was its most recent President.

How did you decide on a career in medicine?

Like many who ultimately end up as a physician, I especially enjoyed math and science during my high school days. At DePauw University, in Greencastle, Indiana, my initial major was Geology. But then things took a turn. During the summer between my sophomore and junior years of college, “just for fun” I spent some time shadowing my Family Medicine doctor and was immediately “sold” on a career in medicine. The patient interactions, the problem-solving, and the sense of making people “better” were just several of the reasons that helped me realize (and decide) that medicine was a great fit for me. So, my last two years of college I played catch up with the need to complete the requisite chemistry, physics, and biology courses necessary for applying to medical school. I ultimately was accepted to The Ohio State University College of Medicine, just three weeks before classes started!

What made you pick Emergency Medicine as your specialty?

I think my reasons mirror others who choose Emergency Medicine (EM) as a specialty.  During the core rotations of my first clinical year of medical school, I really enjoyed each of them. Breadth versus depth has always been appealing to me. This along with the variety, pace, and acuity helped drive my decision. Also at that time, Emergency Medicine was a very young specialty, having only been approved as a specialty by the American Board of Medical Specialties in 1979. Thus, there were great opportunities for residency-trained EM physicians at this time. Emergency Medicine today, as was true in its early days, has always had a singular charge to care for all those that arrive at its door – no matter the complaint, the reasons, or the patient’s ability to pay. This resonated with me in 1979 and still resonates with me today.

It seems that more medical students are pursuing interdisciplinary careers and degrees (MD/MPH, MD/MBA, etc.). Can you describe how you managed to combine your career in medicine with your interest in leadership?

First of all, I think it is fantastic that more medical students are seeking dual and interdisciplinary degrees. This creates short- and long-term opportunities for them both personally and professionally.  Medicine desperately needs its “next generation” of leaders. Those who have these additional skills sets will be well equipped to take the reins in the coming years.

As I mentioned earlier, EM was the “new kid on the block” in 1982 when I finished my EM training at Wright State University in Dayton, Ohio. I had no specific or initial plan to become involved in EM activities outside of my clinical responsibilities. Yet, I have always had the desire to “make a difference” wherever I have found myself. Because of its youth, numerous EM leadership roles and responsibilities existed. My first foray into leadership was an Emergency Medical Services (EMS) medical director. Other opportunities quickly followed – an ED medical director, an associate program director for an EM training program, president of the Indiana Chapter of the American College of Emergency Medicine (ACEP) and vice-chair of the Department of Emergency Medicine at the Indiana University School of Medicine (IUSM). In 2005 I was elected to the Board of Directors of the American Board of Emergency Medicine (ABEM) and this last year had the distinct honor as serving as ABEM’s President. I strongly believe that balancing my clinical responsibilities with these various leadership positions have complimented each other throughout my career. One informs the other; without one, the other would not be complete. All the leaders, including myself, within Emergency Medicine are ultimately striving for the same goal – to improve the care of our patients.

In your blog, I see that you are an oral examiner and test item writer. Drawing on your own experiences, where do you see the future of medical education going?

For the majority of my medical career I have interacted with medical students. In addition to bedside teaching with 4th year medical students during their core EM rotation, I have had the opportunity to sit on the Curriculum Council for the IUSM. Much like healthcare, medical student education is transforming before my eyes. Not surprisingly, there are both opportunities and challenges.

The educational formats in which students now “learn their craft” are becoming more student-centric. Team-based learning, problem-based learning, simulation, and online resources make learning dynamic, interactive, focused, and meaningful. Medical educations’ coming years will expand upon these educational methods with less-and-less formal didactics being the norm.

Curricular content will have new and different priorities. Yes, the traditional body of knowledge will continue to receive their due, but new areas of emphasis are emerging – patient wellness, disease prevention, patient safety, chronic disease management, and health care delivery. Command of these areas are a must for any physician practicing in the coming years.

Curricular changes centering on patient interactions will continue to evolve. There needs to be earlier and consistent patient contact, not just during the latter two years of medical school, but across the four-year continuum. The benefits are self-evident and will assist in meeting the new content areas mentioned above.

Medical school enrollment continues to climb. Students ultimately need patients to develop and hone their clinical skills. Faculty are experiencing greater and greater pressures to be clinically productive. Faculty have less time to teach. There is less money available to reward faculty for their teaching efforts. This, I feel, is one of the biggest challenges for medical student education in the coming years – an increasing demand for clinical experiences, yet fewer faculty to provide this essential experience and teach at the bedside. Simulation may fill some of this gap, but I fear it will not be enough.

Residency slots have been capped since the late 1990’s, yet total medical school enrollment has increased by over 25% in the last 10 years and new medical schools are on the horizon. Students’ ability to match in their desired specialty is becoming intensively competitive and more students find themselves “scrambling” for residency slots if they do not match in a program from their preference list. This is a real problem we are seeing occur here at the IUSM. Many national medical organizations are working to lobby Congress (the majority of residency slots are financed through CMS) to expand the number of residency positions. To date these efforts have been unsuccessful. Couple this with the recent Institute of Medicine (IOM) report on graduate medical education and one can easily foresee continued struggles for training programs to keep pace with the ever-expanding number of graduating medical students each year.

Every few weeks there appears to be a new report discussing burnout rates of physicians and the fact that many would decide not to pursue medicine if given the chance. In this somewhat disheartening environment, what do you see as the biggest challenge to current medical students?

The amount of debt (now averaging nearly $200,000 per student) is a real financial challenge facing almost all students. Navigating this “albatross” during and after residency will require discipline and patience.

During medical school, all of us create an “image” as to what medicine and our individual practices will look like once the training years are completed. The last decade has in many respects turned medicine upside down. The changes are coming fast and furious. I personally do not think anyone’s crystal ball can accurately predict what medicine will truly be like in 10-15 years. This creates uncertainty and each physician will need to reconcile within themselves how to approach this uncertainty.

The pressures of today’s medicine take many forms. The expectations of patients, regulators, administrators, third-party payors, licensing boards, and certifying boards to many feels like a “mountain without a top.” More paperwork, more hassles, more intrusion, and less autonomy are real. By many accounts, the “fun” of medicine is quick dwindling. All this leads to physician dissatisfaction, burnout and more physicians leaving medicine. The challenge for medical students is to approach their career with “eyes wide open.” Yet, we have chosen one of the truly greatest professions. We are provided the unique opportunity to help patients each and every day. Never forget that. When the door is shut and it is just you and the patient – what a privilege it is. Stay the course. Remember why you went into medicine. Go back and reread your personal statement for your medical school applications. This will keep you grounded and will help you to “weather the storm” of an ever-changing healthcare landscape.