20

Resident Training and the Medical

Emergency Team
Geoffrey K. Lighthall

Introduction
Periodic re-examination of health care delivery systems have led to reforms
aimed at improving the welfare and safety of patients. Medical Emergency
Teams (METs) have emerged at the same time as resident work-hour
restrictions have come into effect, public awareness of medical error has
increased, and new models of residency program accreditation have
been proposed (1,2). While well intentioned, the noted reforms and
improvements in health care have not emerged as a coherent and user-
friendly package. Concerns over medication error, for example, have led to
directives for computer entry of drug orders, but this is not always com-
patible with a desire to maximize time at the bedside in the face of work-
hour limitations. Likewise, the implementation of protocols and pathways
that have provided higher quality of care may pose a threat to the concept
of applying and individualizing basic and clinical science at the bedside.And
while resident work-hour restrictions have been promulgated as a measure
to improve patient safety, compliance with these new rules means even
greater reliance on shift care or cross-coverage schemes, where there is
greater likelihood that physicians will be responsible for patients with
whom they have little familiarity.While numerous challenges abound in res-
ident education, the question here is whether the implementation of a
Medical Emergency Team (MET)—a classically patient-centered interven-
tion—interferes with medical education, or whether there are ways in which
medical education can be enhanced through the existence and operation of
a MET.

Origins of the MET: A Solution to a Real Problem

The impetus to create Medical Emergency Teams comes from studies exam-
ining the quality of care and clinical decision making in patients who expe-
rienced cardiopulmonary arrest, or who had unplanned admission to an

217
218 G.K. Lighthall

intensive care unit (ICU). The studies were notable for demonstrating great
variations in quality of care, and in particular, the widespread finding of care
that was inadequate.
Studies evaluating patterns of ward care prior to ICU admission show a
general lack of time urgency in evaluating and treating patients with abnor-
mal vital signs and other forms of deterioration (3–5). Patients initially
admitted to hospital wards (as opposed to ICU) had up to a 4-fold increase
risk of mortality, suggesting that the nature of the care was a more sig-
nificant determinant of the ultimate clinical trajectory than the admitting
diagnosis (4). Both deterioration in the admitting condition and the
development of new problems were key risks for a worse outcome.
In a study done by McQuillan et al., patients considered to have “sub-
optimal” care had twice the ICU mortality rate of the other groups (6).
Areas considered problematic were: timing of admission (late), and man-
agement of oxygen therapy, airway, breathing, circulation, and monitoring.
Reasons underlying the suboptimal care were “failure of organization, lack
of knowledge, failure to appreciate clinical urgency, lack of experience, lack
of supervision, and failure to seek advice.” Our own experience in examin-
ing the dynamic decision making of house staff in a fully simulated ICU
revealed similar deficiencies, including non-adherence to established
protocols (7).
Two different studies of antecedents to cardiac arrest demonstrated that
75% to 85% of the affected patients had some form of deterioration in the
hours prior to the cardiac arrest (3,8). Nearly one-third of such abnormal-
ities persisted for greater than 24 hours prior to cardiac arrest, with a pop-
ulation mean of 6.5 hours (3). In one series, the majority (76%) of the
disease processes eventually progressing to cardiac arrest were not consid-
ered intrinsically, rapidly fatal (8). In another series, over half of the cardiac
arrests presented ample warning of decompensation: the majority of pa-
tients had uncorrected hypotension, and half of these had systolic blood
pressures less than 80 mmHg for more than 24 hours (9). Other patients in
this series had severe but correctable abnormalities such as hypokalemia,
hypoglycemia, and hypoxemia. This collective experience suggests that
quality of care, more so than the disease, may be responsible for the poor
immediate survival of these patients. Inattention to or unawareness of a
developing serious condition causes the additional problem of hasty deci-
sion making at the time of cardiac arrest. Once a cardiac arrest has
occurred, the clinician’s hand is forced, and ICU admission becomes
mandatory for surviving patients in the absence of a do-not-resuscitate
order.
Problems with establishing proper care were found to exist at multiple
levels: nurses were not calling physicians for patients with abnormal vital
signs or changes in sensorium; physicians did not fully evaluate these abnor-
malities when they were contacted; ICU consultants were not called in rou-
tinely, and senior level or consulting ICU caregivers did not obtain routine
 20. Resident Training and the Medical Emergency Team 219

studies, such as blood gasses, hematocrit and electrolyte studies, that would
have defined the patient’s problem. In cases when laboratory studies
were done, they were not always interpreted correctly, and when they were,
therapy was not always initiated (5). All of the aforementioned studies were
conducted in academic centers where junior team members are tradition-
ally called to evaluate a patient and there is a varying degree of engage-
ment by more senior staff members. Loss of valuable time in patient
evaluation and stabilization may have been further compounded by attend-
ing staff that lack knowledge of seriously ill patients and their problems,
and who lacked the skills to direct an appropriate resuscitation (6,10).
Further, teaching hospitals have also increased their reliance on cross-
coverage schemes, which also have been associated with a higher incidence
of potentially preventable adverse events (11).

General Overview of a Medical Emergency Team

The MET’s composition and scope will vary according to specific institu-
tional needs and staffing patterns. Some have designed METs around the
existing “code teams,” while others use various combinations of critical care
nurses and physicians. Ideally, the MET works best with some constancy in
leadership and team membership. Having a team that draws on a smaller
core of individuals over a wide range of times and schedules is a test of indi-
vidual and institutional commitment, and poses a set of challenges that will
not be dealt with here. Instead, the question of how to incorporate trainees
into the team’s operation will be considered. To provide one example, we
are currently proposing a team with the following composition:

• Intensive care attending or senior critical care fellow as a leader

• Crisis nurse
• Anesthesiology resident or attending
• Internal medicine or surgery resident

The overall goals are: (1) perform a quick analysis of vital signs, ventilatory,
and oxygen delivery status to assess the severity of acute and chronic con-
ditions, (2) make timely decisions about triage, goals of care, or need for
the involvement of other services (surgery, cardiac catheterization labora-
tories, etc.), and (3) rapidly stabilize respiratory and cardiovascular status
prior to ICU transfer if needed. Moreover, the approach needs to be pre-
dictable and systematic.
This design reflects a desire to use the minimum number of people to
accomplish all tasks related to the team goals: patient examination and his-
torical investigation, invasive procedures including mechanical ventilation,
analysis of laboratory values and clinical course, communication with con-
sultants, and ongoing monitoring of patient and care plans until transfer to
220 G.K. Lighthall

another setting. Additionally, the presence of an ICU attending physician

assures proper supervision and backup for invasive procedures and airway
management. Pharmacists, respiratory therapists, and electrocardiogram
technicians can be summoned as needed without being part of every MET
call. The primary caregiver or team would also be summoned to participate
in evaluation and decision-making.

Concerns Over Implementing a Medical

Emergency Team
While barriers to MET implementation are discussed in detail in Chapter
9, a brief discussion is needed here to understand the complexity of the bar-
riers to implementing a teaching program that includes METs.
Acceptance and sustained success of METs has historically involved
the cooperation and support of all major departments and services that
interface with the team or its patients (12). In approaching department
heads about instituting a MET, concerns that one should anticipate are:
(1) whether the MET will move decision making authority away from
the physician or the service with primary responsibility for a patient,
and (2) whether the team’s activity will deprive trainees of valuable patient
care experience. We will examine how these concerns may have originated
and critique the current state of affairs, and see that, at its core, the
MET is more about restructuring resource delivery than about radical
change.
One can understand, if not sympathize with, departments that are reluc-
tant to accept an extra- or multi-departmental group caring for patients
in their service. Yet interdepartmental cooperation frequently occurs at
bedside, where the caregiving team is happy to relinquish significant por-
tions of a patient’s care management to a cardiologist, nephrologist,
surgeon, or oncologist. Indeed, the latter specialties possess certain types of
technology, protocols, and detailed knowledge of pathophysiology that can
be key to the optimal care management and survival of a patient. In the
context of specific organ-based derangements, it is rational to seek this type
of support—so why not for critical illness as well? Intensive care may be
poorly understood by other physicians, and mainly in narrow, stereotypic
roles such as the use of mechanical ventilation, invasive monitoring, and
hemodynamic support. In addition, the appearances of illnesses that per-
meate multiple systems do not present clear triggers for consultation with
critical care specialists. To some extent, this is a fault of critical care spe-
cialists, who have not done the best job informing colleagues to the nature
and spectrum of critical care (13). Likewise, criteria defining “critical
illness” have been lacking. Unlike the patients with either myocardial
infarction or anuria, it is difficult for physicians to identify when a constel-
 20. Resident Training and the Medical Emergency Team 221

lation of nonspecific findings becomes a critical illness. Finally, without good

feedback to ward medical teams as to the type of patients that end up in
the ICU—and especially the ones that do poorly—intensive care has failed
at creating demand for its services outside of the ICU.
Concern over lack of resident experience gained in caring for unstable
ward patients probably comes from a fixation on the concept of the MET
as an extension of ICU personnel to other patient care domains. However,
most METs have some role for resident participation and the overall model
is not rigid (12,14–17). Some teams have had the ICU resident participate,
and others have used a senior ward resident on a rotating basis. In any case,
the common denominator of nearly all MET systems is a concurrent
summons of the primary ward team (18). Involvement of the primary team
is beneficial to patients not only because it builds upon an existing rela-
tionship, but also because it creates a bridge of continuity where vital infor-
mation can be passed on in the proper context. From a training perspective,
having the primary ward team work with the MET not only maintains their
exposure to interesting cases and proper care management, but also
demands some agreement of care goals, and when there is no consen-
sus, begs for an evidence-based settlement. Additionally, as MET team
members, medical residents achieve cross-discipline training by caring for
surgical patients, and surgery residents can gain valuable experience caring
for medical patients. Since most METs have been developed outside the
United States, the uninitiated can be confused by the description of some
teams; teams are mostly composed of senior ICU nurses in the United
Kingdom, senior residents and clinical fellows in Australia, and ICU nurses
and physicians in the United States (19). Table 20.1 describes current resi-
dent involvement in different teams and the rough equivalent to post-
graduate trainees in the United States (20).
Will a MET interfere with resident training, or more specifically, deprive
the junior-level trainee of practical, problem-solving experience? Different
types of arguments have been unconsciously incorporated into the culture
of medical training: that it is the mission of residency training programs to
provide experience and training to residents through the care of patients,
and cognitive challenges and decision making are the payoffs for the invest-
ment of time, emotion, and hours of dull, unsatisfying work. Unfortunately,
we are now learning that the current system has been hazardous to unsta-
ble patients, and the MET owes its genesis to the poor outcome of this
population (3,8). Residents have other responsibilities and activities
besides ward patient care (such as the operating room or clinic) and are not
always available for evaluation of patient vital sign abnormalities. Instead,
temporizing measures are instituted over the phone, and data and impres-
sions gained from a bedside examination are frequently lacking. Valuable
time is wasted as evaluations and decision-making proceeds slowly up a
traditional hierarchy (3). Further, many resident teams feel that the care of
 222

Table 20.1. Composition of different Medical Emergency Teams

Trainee Description
G.K. Lighthall

(UK and Australia) US equivalent Study author

Bristow (15) Bellomo (18) Lee (17) DeVita (19) Goldhill (20) Buist (14)
Intern Subintern/intern
Resident Intern, early resident 2 X MD use
SRMO/registrar Junior resident unclear
Senior registrar Senior resident/fellow 2 X MD use
Fellow/deputy consultant Junior attending X unclear
ICU faculty/consultant Attending as needed leader X
ICU/CCU nurse X X X 2 X X
Specific mention of including X X X X
primary team if available
Other personnel (resp. X
therapy, pharmacy, etc.)

Key and abbreviations:

X = presence of house officer or staff member on team
2 = 2 members at the same training level (in 2 studies, a description of physicians on the team was not made)
SRMO = Senior resident medical officer
 20. Resident Training and the Medical Emergency Team 223

unstable patients is a test of their mettle, and that to solicit outside help is
a sign of weakness. In many instances, the team’s attending physician is
never called to help with evaluation. Even when an one is summoned, they
may not have the best understanding of how to prioritize diagnostic and
stabilization efforts and organize and lead a multidisciplinary team, or
possess the technical skills and knowledge required by the situation.
Medical training is structured around the concept of gradually increas-
ing responsibility and decreasing supervision, and a belief in learning from
mistakes. Given this, it is reasonable to consider whether a team-oriented
approach to unstable patients undermines medical education by depriving
residents of the ability to make and learn from their medical decisions. An
argument could be made that there is little to be gained from allowing mis-
takes to occur (21). Observational studies in the intensive care unit as well
as in a simulated environment have demonstrated that physicians make
errors without even realizing that they occur (7,22); in the case of real
patients, it is difficult to imagine how any educational benefit could result
from such mistakes if the physician is unaware of them. When errors are
detected, there is great variability among individuals, departments, and
specialties in acknowledging errors and their sources. In one study on self-
reported errors—despite 90% being associated with serious outcomes—
only 54% of the house officers discussed their mistakes with an attending
physician (23). In a more recent study of morbidity and mortality confer-
ences in internal medical departments, cases containing errors were pre-
sented in less than half of the conferences, and were addressed as errors in
only one-half of the applicable instances (24). By the authors’ estimation,
a substantive discussion of error would occur in the studied department’s
morbidity and mortality conferences only 7 times a year.
If one of the prime modalities of resident training is learning from mis-
takes, additional thought should be directed toward maximizing the yield
of this process. Simulation training may be a superior alternative to prac-
ticing on patients—especially for development of crisis management skills
(25–28). Simulation training for individuals and teams provides greater
exposure to situations that generate errors, and allows residents to acknowl-
edge errors immediately after they occur and to discuss them with peers
and senior staff in a constructive, non-punitive environment (7,29). The use
of simulation training as part of MET development will be discussed in
greater detail below. To summarize here, the MET is not likely to interfere
with the assimilation of knowledge and experience in residency training.
There is good evidence that allowing too much independence in critical sit-
uations may create errors and hazards that are not known, caught, or dis-
cussed in a manner that maximizes the educational yield of each mistake.
Resident participation in a MET rearranges resident responsibilities in a
way that maximizes patient safety and survival, and may in part replace the
ethically untenable system of “learning from mistakes” with one that does
things the right way.
224 G.K. Lighthall

Procedures
Depending on design, a MET may differ from the current mode of ward care
by having attending physicians or fellows involved early on in an evaluation
and resuscitation. At first glance, this “top-heavy” approach may seem to
deprive residents of valuable experience in performing procedures and eval-
uating bedside and laboratory data. Personal experience as a triage attend-
ing suggests that the opposite is true: when working with medical or surgical
house staff to evaluate and stabilize patients in their care, the primary teams
are typically pushed toward doing more—whether it is obtaining arterial
blood gas studies, placing arterial or central venous catheters, or making
changes in ventilatory or fluid therapy. Residents are actually encouraged to
look deeper into the patient’s problems and to understand more.
Not all critical care attending physicians are likely to participate in a
MET; rather there is likely to be a self-selection bias toward those with a
more hands-on approach to patient care. Having the MET led by a critical
care-based faculty member or fellow is likely to bring to the bedside
someone who is comfortable supervising and performing procedures, and
who has the skills to back up the care by the primary team. To give a con-
crete example, our proposal for a MET includes a technology bundle that
features a portable blood gas/chemistry analyzer, a portable monitor that
can display invasive pressures and exhaled CO2, and a portable ultrasound
machine for analysis of cardiac structure and function. Thus, while the
overall mode of care may be different for a ward emergency, the MET
brings with it new and perhaps more advanced opportunities for patient
evaluation and skill development.
Another example is central lines. Many of our residents on the ICU rota-
tion complain that they get little experience placing central lines because
the majority of patients have them placed in the operating room. However,
these residents, hungry for experience, rarely place central lines on patients
in the emergency room or in the intermediate care unit—even when indi-
cated for safety reasons (for example, vasopressor administration) or by
clinical evidence (for example, as a guide for fluid therapy in early sepsis)
(30). With the loosening of critical care boundaries that would be seen with
a MET, residents will learn more about different invasive procedures, their
indication, and the interpretation of their data. Although unproven, we feel
that based on this understanding, residents will actually perform more pro-
cedures than at present.

A Win-Win Situation
Many of the changes in health care delivery associated with METs are likely
to facilitate the development and assessment of competencies now required
by the Accreditation Council for Graduate Medical Education (ACGME)
 20. Resident Training and the Medical Emergency Team 225

and the American Board of Medical Specialties. As part of the Outcomes

Project, ACGME residency review committees have required accredited
programs to develop competencies in 6 key areas: (2)

• Patient care
• Medical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• System-based practice

Accordingly, residencies must define specific skills or knowledge for each

competency and provide training to attain those objectives. Viewed as a
whole, governing bodies not only expect trainees to assimilate medical
knowledge in specific areas (as is still required to pass board examinations,
qualify for fellowships, etc.) but also develop a more dynamic style of prac-
tice. For application of medical knowledge, this means the resident in train-
ing must be able to understand the natural history of a certain disease or
finding, seek recent information that applies to the patient’s case, critically
evaluate the differences between the contexts of a given study and the clin-
ical context of the current patient, and from this, synthesize a treatment
plan. At the same time, a premium is attached to understanding patient
needs and to develop models for shared decision-making. Finally, the resi-
dent is also required to attain some understanding of health care systems
in general, and how their economics and structure impact the delivery of
patient care.
Reading this description conjures up the image of an outpatient physi-
cian managing chronic illness with the struggles of balancing efficacy, cost,
and complexity of treatment. However, ward emergency care also provides
the opportunity to understand the interaction between individual needs and
disease processes, care delivery systems, concepts of resource utilization and
the culture of academic medicine. In fact, resident involvement in a MET
will quite likely provide a reliable structure in which some of the compe-
tencies may be mastered, particularly those aspects of “patient care” that
arise as urgent, life-threatening situations. The latter is an area of medicine
where the stakes are very high and typically not accompanied by an equally
high degree of faculty expertise, supervision, and mentorship. Creating a
system—albeit a “top heavy” one—where patient care is enhanced by early
expert intervention should be regarded as a win-win situation, even in the
context of medical education.
226 G.K. Lighthall

How a Medical Emergency Team Can Teach Residents

about Patient Safety
Emergency ward care also provides a microcosm of health care in which
other competencies can be mastered. Practice-based learning requires not
only evaluation of medical evidence in literature, but improvement in care
based on the analysis of experience using a systematic methodology. As part
of systems-based practice, residents are required to “effectively call on
system resources to provide care that is of optimal value” (2). The existence
of a MET reflects an institution’s commitment to self-examination and its
willingness to rearrange resources and disciplinary lines to create more effi-
cient care and better outcomes for patients—but what is really learned from
this? Some direct learning objectives can and should be built into MET
operation, but a trainee will also benefit from the collective unconscious of
an institution that encourages:

• Doing things the right way—placing a premium on patient safety over

training
• Understanding the connection between events and errors, how sources
of errors are analyzed, and how change results from this
• Understanding how safety underlies patient-system, doctor-patient, and
doctor-system relationships and how institutional, cultural, and individ-
ual change has come from this focus
• Appreciating multidisciplinary teams and teamwork

While the MET aims to provide immediate service to patients in need,

an educational component can be designed into its operation in a number
of ways. First, the MET should engage in research that monitors patient
outcomes and ensures that its calling criteria are properly aligned to the
target patient population. Data from cardiac arrests, ICU admissions,
quality assurance projects, and disease-specific treatments can be analyzed
to understand patient care characteristics, and any gaps that need to be
filled. Second, the MET should have routine debriefings (immediately after
the event is best) with an emphasis on self-critique, team dynamics, and
error analysis. Competency assessments can be designed into debriefings,
and enhanced by the use of audio- or videotape analysis. Error analysis can
provide important insight into whether improvements need to be made in
technical training, teamwork, or organizational structure (31,32). The
overall handling and discussion of errors and “near misses” is likely to
increase the extent of error reporting if done in a proper manner. A system
that that rewards admission of mistakes creates a healthy climate where
there is a greater likelihood of identifying and correcting “latent” sources
 20. Resident Training and the Medical Emergency Team 227

of future errors (29). Residents exposed to such a culture of safety may let
this philosophy shape behavior and improve patient care in other settings.
In brief, the role of the resident is likely to change with the inception of
a Medical Emergency Team. Despite what some may perceive as a loss of
autonomy or independence with the change, a more favorable structure for
patient care could be the product. Table 20.2 summarizes some differences
one would likely see.

Table 20.2. Effect on Residents of a MET

Training Objective Current Status With MET
Patient evaluation Relatively independent, gain Get to see a refined operation
and therapy sense of responsibility Learn proven methods of evaluation
Bad habits may be reinforced Consistent method of analysis applied
No clear feedback on what Can develop models for individual
was done correctly or not actions within framework of a team
Heterogeneity in methods Latest evidence and methods likely
Process based on individual applied
action Process based on multidisciplinary
teamwork
Resident education Learn through experience See evidence-based methods applied
and medical Time-critical mistakes can strengths, weakness
knowledge be made while “learning Debriefings allow appraisal of
that address by doing” Would see development of curricula
Culture of “see one, do one” that address acute resuscitation
Would receive some training on
teamwork concepts
Patient safety Occasional discussions High-reliability organization concepts
roundson patient safety Provides a model for a “culture of
during rounds safety”
Different institutions are Allows design of a process that
studying threats, or “near includes debriefings and open
misses” analysis of actions
Morbidity and mortality, Potential for videotape review of real
QA conferences events
Culture of “see one, do one” Recognizes need for simulation and
practice
Invasive procedures Senior resident supervises Expert may perform procedure if
(might not be that skilled) time is critical (resident gets to see
May be avoided due to lack procedure done right)
of comfort or lack of Expert supervises resident during
expertise later procedures, (mistakes and
Other party performs the technique lapses are corrected)
procedure Emphasis on comfort, speed, and
Patient comfort and safety safety
variable Structured and systematic use of data,
Unclear use of data from Patient benefits from procedure
invasive lines with potentially less risk
228 G.K. Lighthall

Table 20.2. Continued

Criteria for calling medical emergency team:

Airway
Respiratory distress
Threatened airway
Breathing
Respiratory rate >30 breaths/min
Respiratory rate <6 breaths/min
Oxygen saturation <90%
Difficulty speaking
Circulation
Systolic blood pressure <90 mm Hg despite treatment
Pulse rate >130 bpm
Neuroligic
Unexplained decline in mental function
Agitation or delirium
Repeated or prolonged seizure
Other
Concern about patient
Uncontrolled pain
Failure to respond to treatment
Unable to obtain prompt assistance

Promoting Performance Standards: A Role for

Human Patient Simulation
As opposed to a cardiac arrest team, the MET is charged with managing a
wide array of conditions with greater diagnostic and therapeutic uncer-
tainty. Therefore, the goals of the MET are best achieved by programs com-
mitted to additional training and continued re-examination of performance.
From the outset, training activities should be geared toward managing
critical conditions that commonly recur in the pre-arrest stage. Experience
with antecedents to cardiac arrest and ICU admission has led to the devel-
opment of a list of calling criteria that are designed to identify patients at
risk (12,14,33). One such list, published by Buist et al. is reproduced below
(14).
These different types of emergencies require different tasks and prior-
ities, and the role of personnel will vary according to the situation. Non-
technical aspects of patient care, such as teamwork, leadership, and task
 20. Resident Training and the Medical Emergency Team 229

distribution, are probably best applied to real emergencies if they have been
practiced at an earlier time. Medical simulation has been used to teach crisis
management skills in a number of acute care professions, including critical
care, and is a natural fit for MET training (7,30,34). As a training modality,
human patient simulation guarantees the resident exposure to the desired
case mix, and at no risk to the patient. Ideally, the MET will have periodic
practice sessions to maintain competency, refine methods, and to in-
corporate new members. Scoring systems that rate individual performances
in the management of specific patient emergencies have been developed
and used in simulated patient scenarios, and may be applicable to the
training and evaluation of MET teams as a whole (34,35).
As an operating principle, the MET should practice evidence-based med-
icine. Simulation training provides an opportunity for team members to
discuss new diagnostic modalities and therapies and to rapidly incorporate
them into team operations. There is certainly a basis for resident attendance
and involvement in such activities, and this alone can provide some direct
training experience in crisis management as well as engender some consis-
tency in the evaluation of patients in uncontrolled settings.
The use of vasoactive and analgesic medicines in medical emergencies is
vastly different from that in other settings, including advanced cardiac life
support emergencies; our own work in ICU crisis simulation suggests that
this remains an esoteric body of knowledge and a frequent source of error
(7). A simulated environment is especially valuable in learning the use and
pitfalls of these medicines for different types of patients and in dynamic
situations. Most residencies lack direct skill development in crisis manage-
ment, so, insofar as a MET can increase exposure to and assimilation of
such skills, it should be regarded as another plus for the training of medical
residents.

Summary
The need to train and develop house staff for independent practice may
conflict with the needs of patients who require rapid stabilization. Finding
a healthy balance between the 2, where the patient receives the best care
possible, is a challenge to those in academic medicine. Increasingly, data
suggests that the traditional models of resident training have in part failed
to place the patient first. The contributors to this text believe that the imple-
mentation of Medical Emergency Teams will offset some of these short-
comings in care and improve the public accountability of medical
education. The MET can also offer opportunities for the development of
competencies in patient care for both trainees and established physicians.
Likewise, the MET can provide an educational structure from which house
staff can learn a great deal more about interdisciplinary teamwork, patient
safety, and the responsiveness of health care to patient needs.
230 G.K. Lighthall

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