Profile in Innovation: Rebecca Smith-Coggins, MD
In Silicon Valley, “innovative” is often used to describe technology, biotechnology, or software. But before there can be tangible breakthroughs, there must be innovation in paradigms, in deconstructing what was once considered a fundamental approach.
Rebecca Smith-Coggins, MD has been the standard-bearer for two fundamental shifts in emergency medicine: education and physician wellness.
The emergency medicine specialty was less than a decade old when Smith-Coggins finished medical school. To augment fledgling emergency medicine training, she dual boarded in internal medicine and came away with a vision for what emergency medicine education could entail. “Emergency medicine was in its infancy and internal medicine really provided the backbone for training,” she explains.
In June 1991, under her guidance, Stanford Medical Center accepted eight individuals into a new emergency medicine residency program with Smith-Coggins serving as director, a role she held for twelve formative years. Smith-Coggins also served on the residency review committee for the Accreditation Council for Graduate Medical Education (ACGME), helping craft the framework and content for residency programs throughout the country.
During this time, Smith-Coggins began to explore the impact of fatigue among attendings and residents. She led a study evaluating if a 40-minute nap in the middle of the night shift could improve physician performance. By measuring reaction time, she could quantify how those who napped had less performance degradation over time. Smith-Coggins’ work led to the mandate of a nap room for residents or free rides home at the end of overnight shifts.
“I was very interested in sleep research and was fortunate to work with Dr. William Dement [now professor emeritus of Stanford Psychiatry and Behavioral Sciences and founder of the Stanford Center for Sleep and Medicine],” she notes. “Dr. Dement was one of the world’s leading authorities on sleep disorders and the dangers of sleep deprivation. In my work with him, I realized what a struggle it is particularly for emergency medicine.”
Smith-Coggins and Dement collaborated with Mark Rosekind, Ph.D. – then at Stanford and later the 15th Administrator of the National Highway Traffic Safety Administration – on studies to measure sleep deprivation and provide alertness strategies. Smith-Coggins also served on the NASA Fatigue Countermeasures Group during a sabbatical from Stanford where she delved further into the research process and use of simulation as a tool to measure physician fatigue. She went on to develop a simulation curriculum for emergency medicine residents, and then a simulation fellowship with Stanford Department of Emergency Medicine, serving as fellowship director. Smith-Coggins also spearheaded a student wellness initiative at Stanford that outlined the need for more resources and a stronger safety net for student wellness.
In 2006 Smith-Coggins was appointed Associate Dean for Medical Student Life Advising and, with others, started the Office of Student Wellness in 2013. “We [Stanford] were one of the first, if not the first in the country to create this kind of position, well in advance of similar efforts,” she notes. “We went from this voice in the wilderness trying to raise awareness of what was considered a fluffy social science [physician wellness] to now leading the field in what has become a topic of national concern.”
Smith-Coggins efforts established the foundation for the Stanford Medicine WellMD Center and the creation of one of the first Chief Wellness Officer positions at a major medical school.
And in 2018, Smith-Coggins was instrumental in launching another first: a physician wellness fellowship in emergency medicine with Stanford Department of Emergency Medicine.
“It has been personally rewarding in my career to look beyond existing limitations,” she notes. “To recognize opportunities and create new programs that enable implementation of a vision.”