Dr Heidi Chumley

From Fire Hose to Automated Sprinkler System 

Heidi S Chumley, MD, MBA

When I went through medical school, we often said learning was like drinking from a fire hose. I still hear medical students say that today. The phrase captures the reality: an overwhelming torrent of information delivered at high pressure, with little time to absorb it all. The sheer volume of material required to become a physician is staggering, and the pace is relentless. 

But what if learning was more like a smart automated sprinkler system? Imagine a system that delivers just the right amount of water at the right time, to ensure optimal growth. That is the vision we are pursuing: precision learning powered by artificial intelligence. 

Internally, we recently partnered with our Innovation and AI team to chart this journey. Our top priority is clear: achieving nearly universal student success through precision learning. This goal is deeply personal to me. Throughout my career, I have worked to expand access to quality medical education for aspiring physicians who were not accepted into the U.S. medical education system. These students are talented and determined, and they make up a significant portion of the U.S. physician pipeline, despite not being admitted to U.S. medical schools. 

But not all students who go to medical school are successful, and "nearly universal success" has often felt out of reach. For the first time in my career, I believe it is possible.   

The Promise of AI in Medical Education 

Think of AI tools as enabling a 100% dedicated academic coach and tutor that holds the combined subject matter expertise of every faculty member. This coach has 24/7 availability. It dynamically creates learning plans, curates content, adjusts modalities, and monitors progress in real time. It can identify when a student struggles and intervene immediately, tailoring the approach to that individual’s needs. 

We are closer than many realize. AI can already analyze performance data, recommend personalized study plans, and retrieve and summarize content. The potential impact on student success is enormous. To unlock that potential, we must overcome several challenges.

The Promise of AI in Medical Education 

Think of AI tools as enabling a 100% dedicated academic coach and tutor that holds the combined subject matter expertise of every faculty member. This coach has 24/7 availability. It dynamically creates learning plans, curates content, adjusts modalities, and monitors progress in real time. It can identify when a student struggles and intervene immediately, tailoring the approach to that individual’s needs. 

We are closer than many realize. AI can already analyze performance data, recommend personalized study plans, and retrieve and summarize content. The potential impact on student success is enormous. To unlock that potential, we must overcome several challenges. 

Challenge 1: Data Quality and Digital Infrastructure 

AI is only as good as the data you give it. Medical school, by design, is not an online program. Instruction happens live. Learning management systems exist but are underutilized because the curriculum was never intended to be digital. 

We need to capture rich, structured data about how students interact with the curriculum. Every lecture, every quiz, every case discussion must generate accurate, capturable, and extensive digital information. Without this foundation, AI cannot deliver precision learning. 

Challenge 2: Balancing Access and Control  
One of the most complex decisions we face is determining appropriate boundaries for AI in medical education. Our guiding principle: AI should augment faculty expertise, not replace it. This means designing systems where faculty-developed content takes precedence, where information sources are transparent, and where human oversight remains essential. In medical education, there are no shortcuts to verification. 

Challenge 3: Building Memory and Continuity 

Finally, effective AI support requires continuity. When a student interacts with AI tools across different courses or semesters, those experiences shouldn't exist in isolation. With appropriate consent and governance, we can work toward more connected experiences. Insights from one interaction can inform the next, helping students build on their progress rather than starting over each time. Done well, this could mean more personalized guidance, earlier identification of students who need additional support, and a learning experience that genuinely adapts to each individual's journey. 

Our roadmap: 

• Digitize the Learning Experience 
  Increase the use of learning management systems and digital assessments. Capture granular data on student engagement and performance. 
• Develop AI-Ingestible Content 
  Structure curriculum materials so they can be indexed, tagged, and analyzed by AI systems. This includes lectures, case studies, and assessments. 
• Pilot Precision Learning Tools 
  Start small. Use AI to personalize study plans for a subset of students. Measure outcomes and iterate. 
• Train Faculty and Students 
  AI literacy is critical. Faculty must understand how to integrate AI into teaching, and students must learn how to use AI responsibly to enhance their own effort. 
• Ensure Ethical and Equitable Use 
  Establish clear guidelines for data privacy, academic integrity, and fairness. AI should be a tool for empowerment, not a source of bias or dependency. 

The Double Helix Approach 

This initiative is part of what I call the “double helix” approach to preparing the next generation of physicians. The strand in this series focuses on teaching students to leverage AI for learning. The other strand addresses how AI will transform clinical practice. Together, these strands form the backbone of a future-ready medical education. 

Closing Thoughts 

The fire hose metaphor has served us well, but it is time to retire it. Medical education should not be about survival; it should be about growth. By embracing AI, we can transform the learning experience from overwhelming to empowering. We can create an automated sprinkler system—smart, adaptive, and precise—that nurtures every student to reach their full potential. 

For the first time, “nearly universal success” is not just a dream. It is within our grasp. And that changes everything. 

Between the Chaos and the Calling: Why Students Still (and Sometimes Don’t) Choose Emergency Medicine

 Between the Chaos and the Calling: Why Students Still Choose (and Sometimes Don’t) Emergency Medicine

By John E. Delzell Jr., MD, MSPH, MBA, FAAFP

Emergency Medicine has long been the specialty of adrenaline and altruism. For decades, it was one of the most competitive matches in the National Resident Matching Program—nearly every program filled, and students lined up to join the front lines of acute care. Yet, as I documented in my previous blog, in the past few years we have watched that once-steady tide recede. In 2023, almost half of EM residency programs in the US had unfilled positions on Match Day. The decline was so striking that it forced a profession known for composure under pressure to stop and ask: What happened?

My previous blog (1) talked about the data from the Match and some of the background issues in the specialty. Now I want to talk about the other side, the students who are considering EM. Three recent studies give us a window into the minds of the students who are either drawn toward—or quietly walking away from—Emergency Medicine. Together, they reveal a complex mix of inspiration, disillusionment, and hope.

The Push and Pull

Kiemeney and colleagues’ 2025 Western Journal of Emergency Medicine study (2) captured the voices of over 200 recent EM applicants. Their findings read like a portrait of a generation standing at the crossroads of medicine’s promises and its pressures. Students were drawn to EM for familiar reasons: the variety of pathology, high-acuity patient care, higher compensation compared to primary care, and a flexible lifestyle. Many spoke warmly of their third- and fourth-year clerkships, and of residents and attendings who modeled teamwork and compassion in the organized chaos of the emergency department.

But the same environment also revealed what pushes students away: corporate ownership influence, crowding in the emergency department, burnout, and anxiety about workforce projections. More than two-thirds of applicants said they were advised against EM—most often by physicians from other specialties. The perception of an oversupplied job market, coupled with the visibility of exhaustion among practicing emergency physicians, created real hesitation.

What’s most sobering is that these deterrents aren’t about medicine’s content—they’re more about its context. Students still love the medicine of EM. They’re just unsure about the system that surrounds it.

Early Exposure, Lasting Impact

The 2018 study (3) by Ray and Colleagues reminds us how EM’s appeal once took root. Surveying nearly 800 applicants (fourth year, EM bound, MD & DO students), they found that early exposure—before or during the third year of medical school—was one of the strongest predictors of choosing Emergency Medicine as a specialty.

Students who worked as scribes, EMTs, or ED technicians, or who trained at schools with EM residencies, made their decision earlier and more confidently. Conversely, delayed exposure often meant that students had already committed elsewhere before they truly encountered the specialty.

That insight still feels true. Students can’t fall in love with what they don’t see. Emergency Medicine, which traditionally appears late in the clinical curriculum, may lose future physicians simply because it shows up too late in their professional identify formation. By the way, this is commonly seen in specialty choice. It can be true for Family Medicine, medical and surgical subspecialties, and other specialties that may not be part of the core clinical curriculum in medical school. 

 Defying the downtrend

A new 2025 study from Brown University by Kerrigan et al.(4) offers a glimmer of optimism. While most of the country saw steep declines in EM applicants, Brown’s numbers actually increased. Their secret wasn’t a marketing campaign or a higher salary projection—it was mentorship and meaningful clinical engagement. Students credited resident-led mentoring, advising from faculty, and hands-on electives during the third and fourth years as decisive influences.

Interestingly, pre-clinical exposure and interest-group events mattered less. Students learned about EM in those settings, but they chose EM only after authentic, human interactions in the clinical environment. Residents—still close enough to remember the decision themselves—proved to be the most trusted guides.

In other words, people and practice still matter more than perception. This was a small study (31 students) from one allopathic school which makes it hard to generalize the results but those feel like good strategies that could work in other settings.

What Students See—and What Can Change

Across all three studies, a few themes are remarkably consistent:

• Physician mentors matter most. Whether in the chaos of a resuscitation bay or the calm of post-shift debriefing, physicians shape students’ career decisions through the moments they share.
• The third year is the tipping point. By that time, half of students have made their specialty decision. If a clinical experience does not happen until the fourth year, the clinical experience is probably already too late.
• Students worry about the future. Job-market uncertainty, “Scope creep,” and corporatization have become part of the specialty’s narrative. Unless national leaders in Emergency Medicine actively address these concerns, it will continue to erode trust.
• Positive culture keeps hope alive. The “people and culture” of EM—its teamwork, humor, and humanity—remain attractive to medical students. Even in difficult times, they remind students why the field matters.

Reclaiming the Story

Emergency Medicine sits at a defining moment. Its students see both the calling and the cost. They know that the specialty saves lives, but they also see the toll it takes on those who practice it.

If Emergency Medicine’s leaders want to reverse the trend, there needs to be more than workforce data. They will need stories—of balance, belonging, and purpose. They need to invest in resident mentors and clinical clerkships. EM needs to show students that the specialty is not just a job in crisis—it’s a career built on courage, adaptability, and service to every patient who walks through the door.

When students step into an emergency department and see compassion under pressure, they still fall in love. That spark is still there. The challenge for educators, leaders, and professional societies is to keep it alive long enough for them to choose it.

References

1. https://educationinmedicine.blogspot.com/2025/10/emergency-medicine-at-crossroads.html

2. Kiemeney M, Morris J, Lamparter L, et al. Push and Pull: What Factors Attracted Applicants to Emergency Medicine and What Factors Pushed Them Away Following the 2023 Match. West J Emerg Med. 2025; 26 (2): 261-270.

3. Ray JC, Hopson LR, Peterson W, et al. Choosing Emergency Medicine: Influences on Medical Students’ Choice of Emergency Medicine. PLoS ONE. 2018; 13 (5): e0196639.

4. Kerrigan D, Knopov A, Lipner K, et al. Defying the Downtrend: Factors Driving Medical Students to Pursue Emergency Medicine. AEM Educ Train. 2025; 9: e70057.