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Letter to the Editor: The Collegiate EMS AdvantageI have written and lectured many times on why Collegiate EMS exists and why it is critical that Collegiate EMS continue to grow. The general argument touts the benefits Collegiate EMS offers to those who participate in it. For example, Collegiate EMS teaches self-confidence, interpersonal skills, teamwork, leadership, organization skills, responsibility, decision-making, and critical problem solving. Pre-hospital medicine really just provides an avenue for the acquisition of these life skills. Last fall though I was involved in training a group of first year medical students in CPR, and I thought, "What is the Collegiate EMS advantage to those who continue on in healthcare and specifically medical school (according to a survey conducted at a recent National Collegiate EMS Foundation Conference, less than 50% of Collegiate EMS participants)? Is the advantage to medical students any different than it is to other participants who pursue other careers? Certainly all the same lessons apply, but how far does the prior exposure to pre-hospital clinical emergency medicine and direct patient care carry new medical students?" It is commonly accepted that EMS certification alone does not help in entrance to medical school. Holding a certification card may demonstrate interest in medicine and some degree of commitment to the profession; however, becoming an EMT has become quite commonplace such that it no longer stands out as something unique or overly impressive on a resume. There are, of course, some exceptions depending on what one does with the certification or if there exists a particular life defining experience gained through EMS that the person is able to write and talk about. Therefore, while the presence of EMS certification on a resume does not necessarily add anything to the application, I think the exposure to EMS is a great advantage to applicants once they are accepted and have begun their actual formal medical education. EMS is one of the few things, if not the only thing, that teenagers and young adults can do to be formally involved in direct patient care prior to medical school itself. As EMS providers, individuals are completely responsible for the evaluation and treatment of a patient. In the time prior to delivery of a patient to definitive care, there are no physicians or higher qualified medical personnel on scene (at least we as pre-hospital providers generally hope that there are not any). The EMS provider is it! As a result, EMS providers turned medical students are already comfortable talking to patients and doing an assessment and physical exam. Certainly there is more to learn in medical school as those skills are further developed and refined, but EMS providers have an unquestionable leg up on their classmates and have that much of an easier time adjusting to the many pressures of medical school. Simply stated, not everything is foreign and new. There is a preexisting comfort level. Additionally, EMS providers who enter medical school are comfortable talking about medicine. They are familiar with the language and the thought process. They are used to presenting patients to other healthcare providers in a succinct, direct manner. They are accustomed to the concept of peer review and consultation. Again, these things are learned in medical school and those without an EMS background are not at a disadvantage. However, the advantage to those with an EMS background is evident. Those who continue in EMS while in medical school also have the advantage of being able to apply some of what they learn as they progress through their education as opposed to having to wait until their third year when they officially enter the wards. EMS provides them with a constant patient population on which to further hone their skills. Having delineated what I believe the advantages of EMS prior to medical school entry to be, I would be remiss if I did not also comment on what I perceive the potential disadvantages to be. First, there is a possibility for a false sense of confidence and unwillingness/inability to keep an open mind to new and different ways of doing things. EMS providers may have a set way of conducting a patient interview and exam. A physician's assessment and exam has similar components but is often different in scope and objective. EMS providers turned medical students should avoid tuning anything out because they "already know it." A physician's instruction on something even as mundane as CPR can be enlightening and change a person's perspective. Second, and more importantly, EMS experience can lead to the premature and inappropriate development of cynicism. The statistics on this are mind-boggling. The majority of first year medical students are determined to be extremely empathic and have far reaching goals of healing the world. Studies on provider empathy show that there is a precipitous decline in empathy with acquisition of knowledge and experience, and the decline seems to begin in the second year of medical school and is downhill from there. It is quite ironic and counterintuitive that in learning to become a physician one's empathy towards patients in fact decreases and cynicism increases. Those who enter medical school with previous patient care experiences are on an accelerated track towards cynicism if not already loaded with it. It should not be that way and there are things individuals can do to change the trend (a subject of several lectures and exercises presented by the dean of my school upon our orientation to second year - in a nutshell, the solution involves commitments to "constant professionalism" and "personal humility.") Good luck to those currently in the midst of the medical school application process (I do not envy you - it is at times a long, tedious course). Think about some of the above issues if you plan on discussing your EMS experience in your upcoming interviews. More importantly, enjoy your senior year to the fullest extent possible, especially if you plan on entering medical school immediately next fall. Your brain will need the rest and relaxation! - Joshua A. Marks |