• prioritizes learner and teacher well-being;
• celebrates educator exemplars; and
• shares innovative curricular tools and best practices.

• Labels – hopefully we’re doing our best now to avoid referring to a patient as “the pancreatitis in room 2” or the “knife wound in trauma 1.” I still hear it, though not as much as I did watching the show. We can and should do better.

• Mistreatment – instances of harassment, belittlement, humiliation, and neglect toward students and interns are everywhere in this show. While mistreatment seems to occur less frequently than it did 20 years ago, still over one-third of US medical graduates reported experiencing mistreatment at least once during medical school between 2014 and 2017. It’s easy for people like me to say, “mistreatment isn’t common anymore.” We need to provide a safe venue for students to talk about this and listen to them. They’re the future of our profession. 

• Disrespect – while not necessarily reaching the level of mistreatment, condescending chatter about other team members or services (surgery <--> medicine, ER <--> OB-GYN, etc.) or jokes in poor taste permeate our CLEs to a much larger degree. The undesirable words we use to communicate with and describe each other can be a way for people under enormous stress to blow off steam. We don’t mean what we’re saying, and the act of venting like this might help us feel better for a few minutes. Our patients see this and are incredulous that we treat each other this way. Our learners see their trusted role models acting counter to the professionalism and high character they learn about when they start medical school and either (1) experience distress from this disconnect that impacts well-being and potentially their health, or (2) get the message that this is the right way to act, thus becoming part of the problem in this vicious cycle. Our leaders may not have great insight into how widespread this is. I don’t think any of us are proud of it. We need to shine a light on this and work together to eradicate it.

• Overworked and overtired – teachers and learners dealing with life and death stuff. We all know that our work is hard. There is no way to bubble wrap our learners or insulate ourselves from this, and since we learn by taking care of patients, we shouldn’t want to limit these experiences. But the absence of reflection and debriefing after difficult events can numb us in a way that isn’t healthy, and limit our ability to learn and improve from these situations.

• Hierarchy – everyone in the show seems really worried about doing exactly what their supervisor wants and avoiding looking foolish. Clearly this is important, as we develop excellence and expertise at least in part due to experience and repetition. But the downside to a rigid hierarchy is that really smart and caring people in medical school and residency may lack the responsibility, courage, or agency to speak up when something doesn’t seem right. In this way, our hierarchical structure limits learning and can negatively impact patient care outcomes. We need to help students develop skills to initiate discussions and foster the courage to ask questions and speak their truth. Furthermore, we must train our faculty and more senior trainees to listen when these bright future leaders speak up. 

• Patients at the center – and lots of them. There are rare moments of being in the doctor’s lounge, but most of ER’s hospital scenes take place at the bedside. And, guess what – no EMR to pull attention away from the patient! There’s eye contact and everything. The CLE is fast-paced and somewhat chaotic, but the patients’ stories feel authentic. While clearly providing advances in care over time, the EMR and other technology must not replace our time and bond with our patients. This relationship must remain our true north. 

• Teaching – we see the third-year medical student everywhere – learning by doing, getting loads of meaningful responsibility, and receiving frequent feedback even on the first day. Sometimes this is crowded out of our busy days as teachers. Remember how important this is and learn/practice the skills of meaningful actionable feedback. 

• Looking out for each other – despite some of the previously mentioned undesirable CLE characteristics shown in ER, the team really cares for each other and supports each other through truly trying and often unimaginable circumstances. A little bit of this can go a long way.