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Dr. Terence McCarthy Leads New Medical School’s Emergency Program

The doctor is the John M. Geesbreght MD, MS, FACEP Chair of Emergency Medicine — the first endowed chair position at the TCU and UNTHSC School of Medicine.

Dr. Terence McCarthy is the Dr. John M. Geesbreght Chair of Emergency Medicine at the TCU and UNTHSC School of Medicine. Photo by Glen E. Ellman

Dr. Terence McCarthy is the Dr. John M. Geesbreght Chair of Emergency Medicine at the TCU and UNTHSC School of Medicine. Photo by Glen E. Ellman

Dr. Terence McCarthy Leads New Medical School’s Emergency Program

The doctor is the John M. Geesbreght MD, MS, FACEP Chair of Emergency Medicine — the first endowed chair position at the TCU and UNTHSC School of Medicine.

You have the first endowed chair at the TCU and UNTHSC School of Medicine. Who is it named for?

Dr. John Geesbreght is really the founder of emergency medicine in Fort Worth. He was the medical director at Harris Hospital’s emergency room for 45 years. He retired on Jan. 1, 2019. So it’s really, really fitting that the chair of emergency medicine is named for Geesbreght. He’s a very good friend and a mentor to me and an inspiration.

Editor’s Note: The interview with Dr. McCarthy predated Dr. Geesbreght’s August 4, 2019, death.

How did you get into emergency medicine?

It’s a long story. The truncated version is that I just liked everything — every single specialty that I trained in as a student, I liked them all. Emergency medicine really does it all. We see the entire age range, and we see the whole spectrum of illnesses from just a little tiny hangnail to people that get run over by a steamroller.

In your position as chair you oversee clinical educational opportunities within the emergency medicine department. Can you break that down?

Right now we’re just trying to build a department. We are recruiting preceptors for our students, the positions that will do the bedside teaching of our students. They will have one student assigned to them during the course of the longitudinal integrated clerkship. Students’ emergency medicine experience primarily will be with their preceptor.

At the medical school, students will see patients right away. Does that include in the emergency department?

No. The first year they will be seeing patients in primary care settings, in office settings. Once they start phase 2 they will start the rest of the specialties such as emergency medicine, OB-GYN, surgery and psychiatry.

What will be different about the medical school’s approach to emergency medicine?

The whole school is so different. The emergency medicine experience will be integrated more closely with the other specialties as well as with the foundational basic science knowledge.

Students will have weekly enrichment programs where they come together and are able to put the basic sciences together with their clinical exposures and really just have that kind of knowledge instilled in them in a much richer way than it would be if we just did the traditional lecture method. It’s really just a different approach to education.

There’s essentially no didactics at the school. It’s all self-study, and then they come together for small-group sessions, problem-based learning, case-based learning and team-based learning and then the enrichment sessions. They engage in an activity that we call “independent knowledge acquisition.” They can also use other things such as videos or whatever works for them to get the knowledge

There’s no big lecture — is that sort of frightening?

Dr. Terence McCarthy said the guiding philosophy for emergency medicine is chaos resolution. Photo by Glen E. Ellman

Dr. Terence McCarthy said the guiding philosophy for emergency medicine is chaos resolution. Photo by Glen E. Ellman

For a traditionalist like myself it is. I had to be dragged kicking and screaming to this approach. What finally convinced me to be open-minded about it was learning about the small cohort of students at Harvard Medical School that have a curriculum that’s similar to ours, or the teaching modalities are similar to ours. You can be really smart book-knowledge-wise but be completely incompetent in dealing with people, with patients. The overarching principle of our school is that we want to raise empathetic scholars. We don’t just pay lip service to that term; it truly is at the core of what the school is all about. The entire curriculum is really designed from the ground up around that concept.

Communication is emphasized. It’s core to what students are taught. It’s woven throughout all four years of the curriculum: Courses that are instruction and practice in communication. We have an amazing faculty group who were hired specifically to teach communication.

It’s not enough just to be empathetic, you also have to be able to show your patients that you’re empathetic, and they do that through communication.

What does empathy, or compassion and sensitivity, look like in your specialty?

It’s actually individualizing your care for each patient. You don’t make it a road encounter. Make sure that you spend enough time with the patient. You have to ask some pretty specific questions, but at the end, you have to ask at least a couple of open-ended questions (Is there anything else you want to tell me about? Do you have any other concerns?); just open that door to them. You have to maintain contact with the patient the whole time that they’re in the emergency department, to be open to them raising new problems or new concerns. At the end, you have to communicate what you’ve done at that visit, what the test results show, what your diagnosis is, how long it will take to get better, what the expected outcomes are.

I started giving my personal cellphone number out to every single patient I see in the emergency department — 100% of them. I tell them, “If you have any questions in the next day or two, text me and I’d be happy to answer.” All my peers are saying, “Are you crazy?” I’ve gotten maybe a 1% rate on that. The people who do text me are so grateful. Someone wrote a really nice email to the hospital president about the great experience the patient had.

Individualize your care for each patient, really make sure you don’t just rubber stamp it.

Emergency medicine is chaotic: You can’t plan or predict who comes in. How do you plan to relay that to students?

This is Geesbreght’s philosophy of emergency medicine: We’re not in the business of medicine; we’re in the business of chaos resolution. This is going to be a guiding philosophy. It doesn’t matter if patients have a little tiny cut on their chins or they got run over by steamrollers — chaos has entered their life, and our job is to put their life back in order. We are in the business of chaos resolution. Both of those patients are equally deserving of compassion and care.

We never second-guess a patient’s decision to come to the emergency department. Our whole goal in this school is not to let our students become cynical or jaded. We want them to hang on to the idealism with which we all go into medicine. That’s really important to us. That’s really what the whole empathetic scholars philosophy is about: Hang on to your idealism.

There are people in emergency medicine who do become jaded. The people who have that kind of outlook will have a patient who has a hangnail and say, “I can’t believe you came into the emergency room for a hangnail.” On the other end of the spectrum, you have a patient with that hangnail that turned into a rip-roaring abscess infection of the arm and you say, “I can’t believe you waited too long.” You are asking patients to pick the one bright shining moment where they should come to the emergency room. You just quit second-guessing their decisions. That person is here, and our job is to get [his] life back in order, to resolve the chaos. You don’t understand all the different factors that go into a patient’s decision to come to the ER. They don’t know when it’s the right time. They’re just asking us to tell them what to do about it.

How will the new medical school introduce specialties to students?

In phase 2, during their longitudinal integrated clerkship, they will have an immersion period in each of the fundamental specialties: internal medicine, OB-GYN, pediatrics and surgery. They will have a two- to three-week immersion dedicated to each specialty. They will have a shorter one for emergency medicine.

After that, they will be doing all the specialties over the entire course of the year. They will be doing all the specialties concurrently, which is very, very different from traditional medical schools. Traditionally, you spend three months of surgery, three months of internal medicine — we’re doing them all concurrently. Part of the reason that we’re doing this is we want all of the knowledge to feed into each other and to be synergistic together.

We want the students to have a longitudinal care of their patients. In phase 1, they will be given a cohort of patients they’re going to continue to follow up with their whole four years of medical school. They will have their own patients together with the physician.

Instead of shadowing a physician for a day and meeting a random patient that students never see again?

That’s exactly what we’re trying to avoid. It will be a way more contextualized kind of medicine. It will be people with diseases instead of a disease state.

The school of medicine is the most exciting thing that’s happened in medicine in Fort Worth — in Tarrant County, really — in the 20 years that I’ve been here.
Dr. Terence McCarthy

Tell me about the recruiting process for gaining preceptors.

The school of medicine is the most exciting thing that’s happened in medicine in Fort Worth — in Tarrant County, really — in the 20 years that I’ve been here. There’s a lot of buzz around this school. People are kind of self-selecting: The right kind of person is the one who’s going to reach out to us, who wants to teach, especially when they hear about our philosophy. I’ve been lucky, I’ve had people kind of beating down the doors to be in the emergency medicine.

We’re going to all these different doctors’ offices and making sure that they are the right kind of people. We really need the right people to teach our students. There are so many physicians in this community; you really do have that idealism, compassion and empathy. They really do practice that way. We just need to make sure those are the ones that we recruit.

In this day and age, medicine is very much about collaboration and appreciating other professionals that we interact with, such as nurses. Medicine is now a team approach. Everybody contributes in a different way. The nurses have their role. We have clinical pharmacists who play a really important role. We have paramedics in the ER, and radiology techs, and the lab. All are doing their thing. You have to interact constructively with all those different professions.

The whole key is to not let silos build up. It has to be a continuum. It’s really important to have systems in place that allow for open communication: interacting constructively with your peers and having good relationships with them. That’s a big part of what we will be teaching our students. That’s where the preparation for practice comes in.

There are so many cool things about this school it’s crazy. The leadership, the people who established it, really had a vision, and they made it come to fruition over the course of the last three years they’ve been working at this. It’s been really interesting to see it all come together.

The overarching principle of our school is that we want to raise empathetic scholars. We don’t just pay lip service to that term; it truly is at the core of what the school is all about.
Dr. Terence McCarthy

How do you teach empathy?

You teach empathy by having the whole curriculum designed around it. It’s not pathology-centered; it’s patient-centered. It’s student-focused and patient-centered, meaning you don’t learn about diabetes in isolation, you learn about what it’s like to be a patient with diabetes and how it impacts her greater life.

The other element is honing communication skills. A big part of empathy is being able to communicate effectively in making it a two-way street.

They’re gaining all the science knowledge, but it’s more integrated. It’s not separated from the clinical portion.

I really remember this experience, learning about congestive heart failure, or Wilson’s disease or whatever it was, and thinking it felt so theoretical. I almost didn’t believe they really existed. I got to my clinical sciences year, and I actually had a patient with Wilson’s disease and saw there was such a thing.

What is it like to be the first in a position at a brand new school?

It’s very exciting. When we first all got together as chairs, we were kind of overwhelmed. But the good thing about this school is that the dean has the same approach to his leadership as he does to the students.

He’s not saying, “Here’s what you as chairs do.” The first conversation I had with him about it, he said, “Terry, you and I are going to define your role together.” And he said, “You should look at it like you’re painting a masterpiece. You get to paint this masterpiece, and we’re going to collaborate on that.” That’s really what it’s like.

We have a dean’s council of chairs that meets every three months. The conversations there are so rich and robust, and everybody just totally thinks outside the box and talks about what we want this school to look like. The dean really wants our input, and he gives us his input. We are designing the way it’s going to work from the ground up. It’s exhilarating. It’s overwhelming. It’s exciting.

You feel like you’re just stepping off into the void, kind of, and see what happens, but we get to have some control over it.

Are you at all envious of the way this medical school was designed, and are there aspects you wish you had in your education?

Oh, for sure. For one thing, for most of us, medical school is kind of a terrifying experience. I mean, there’s a lot of stress in medical school.

There are many stressors. The first part is: Am I smart enough? Do I really belong? It’s not so much that the material is really difficult to understand; it’s really just the amount. It became rote memorization. It used to be people just accepted that medical school was supposed to be really stressful and terrifying. And you just toughed it out and waded through. For this school, we really are intentional at not wanting it to be like that. We really want the students, if they feel stress, to talk about it. We’re doing everything to try to make it not stressful.

The other stressor is that once you’re passing your classes, the next terror point is going to the clinical part of your career. You don’t know what you’re doing. You’re just kind of thrown in, and you’re supposed to learn on your own reading books — how to do procedures — and hope that you have a nice intern or resident who will show you. It was very, very much a hierarchical experience in medical school.

A 2018 Medscape National Physician Burnout and Depression report found that emergency medicine physicians ranked sixth (45%) for burnout by specialty. What is the new medical school doing to find a solution for this?

Our hope is that this is going to prevent burnout because it’s going to let the students hold on to the idealism with which they enter medical school. That’s the intent: That we will have a lot less burnout, we will have more people that love their job, which I still do. I love being a physician.

It’s really exciting and kind of like a conductor of an orchestra: They tell the bassoon when to come in and the woodwinds and the brass. Those are things I learned naturally five or 10 years into my practice.

A big component of the emergency medicine unit will be learning how to coordinate. Collaborating with other professionals is a big part of what we’re teaching them at our school. Communication is integrated into our curriculum.

What leadership skills will the new medical school students learn?

Dr. Terence McCarthy said he wants the medical students to focus on individualizing care for each patient. Photo by Glen E. Ellman

Dr. Terence McCarthy said he wants the medical students to focus on individualizing care for each patient. Photo by Glen E. Ellman

Collaboration, communication, and I think empathy is a good trait for leaders to have. They will learn about cultural differences. They will learn about health care disparities. They will learn about professionalism, and what it takes to be a real professional.

Part of leadership is learning and remaining current through your career. We’re not just teaching them information. We really want to teach them how to be lifelong learners and critical appraisers of information so they don’t take information and just believe it because it is presented to them, but they can actually analyze it and break it down, and see if it’s good information because that’s a really important skill to have in medicine.

The quality of medical literature that is published is variable, and so you have to really be able to critically analyze journal articles and the research and see if it’s really something that you want to incorporate in your practice or not.

Can you describe a situation where you were forced to be a leader?

My first leadership role as a professional was when I was the chief of the division at Harris Hospital. It was fairly early on in my career, maybe seven or eight years, and there were people who had been there for a lot longer than that.

I was suddenly having to be the leader of the division. It was very much a growing experience for me because I learned that being a division chief, it doesn’t really have a bunch of inherent power — I don’t just have the ability to say, “This is how it’s going to be.” So I learned about building consensus and getting input from different people whose opinions I respected and using that input and knowledge from them to convince others that this is the way it should be done. That was my first role where I was thrust into a leadership role kind of unexpectedly.

Is there a mentorship experience that has stuck with you?

I would say Geesbreght has been one of my most important influences as far as how to be a leader. He’s so inspirational, and he has a very interesting leadership style. He’s the kind of person that when you go to him for advice about a problem, like I used to as a diligent young chief, I would keep a list of questions that I had to ask him. I would ask him all my questions, and at the end, I would walk away from the conversation more confused than when I started, but I would be inspired to think that I could fix the problem. He wouldn’t hand you the answers. He would give you new ways of thinking about the problems and then have you go out and implement them. He’s definitely been a big influence on me.

You’ve been recognized as a Top Doctor by Fort Worth magazine eight times, as well as named Outstanding Preceptor twice by UNT Health Science Center and Physician of the Year by Texas Health Harris Methodist Hospital Fort Worth. What do those accolades mean to you?

I feel honored. My self-perception is that I’m just a doctor. I just want to take care of patients. To tell the truth, of all the many hats I wear, that’s still by far the most gratifying to me and the thing I love to do the most. That’s where I go to find my peace.

Going to the ER is the least stressful place of my life. I’m so comfortable in that arena, and I know I have control over what’s going to happen. I’m going to be able to orchestrate patients’ care. I like taking care of patients.

Collaborating with other professionals is a big part of what we’re teaching [students] at our school. Communication is integrated into our curriculum.
Dr. Terence McCarthy

I do the best I can with what I have and I love what I do, so I’m honored to have this position. I’m certainly not one to believe my own press. I really don’t think I’m better than all the docs I work with. I’m just a regular doctor who got lucky. Part of it is that I have high-profile positions, so when people are voting for those things, my name comes to their mind. I’m just a regular doc.

The Physician of the Year award is the award that ruined my life. They took a picture of me to hang in the hallway with all the Physicians of the Year. My picture really looks exactly like Conan O’Brien. It’s really funny. I can never walk down that hall without somebody standing in front of the picture laughing, “That’s Conan O’Brien!” and they look over at me and say, “Oh, there’s Conan!”

One of the chaplains told me, “You know what just happened? A group of TCU sorority girls just came up to me, and they’re on a scavenger hunt and they were supposed to find the picture of Conan O’Brien at Harris Hospital.” It’s my picture. It’s really amazing. I can’t go a shift without somebody saying, “Oh you’re that Conan picture.” I wish I had never won that award.

Why do you think a new medical school belongs in Fort Worth?

There’s way, way more room for another medical school. There are so many patients in this community and not just in Fort Worth but the Metroplex. This population can so easily support another school.

I think that the medical community is really excited about it. I think there’s a real hunger for practicing physicians to be involved in academia. They want to be involved in teaching medical students. There’s something about going through medical school and residency that you just sort of get in that learning and teaching habit. Most of us look back on those times fondly, and most of us want to be involved in that.

A lot of community physicians are really interested in research and the opportunities the school will give them to become involved in research. Physicians are scientists: They like knowledge. They like advancing knowledge if they can. Physicians by and large are kind of scholarly type people, and I think they want to be involved in that process.

Fort Worth is such a great place. I think the TCU and UNTHSC School of Medicine is going to be a really cool one. It’s going to be a good school. I think it’s going to be elite, I do.

Editor’s Note: The questions and answers have been edited for length and clarity.