Medicine is practiced in the room -- between the doctor and the patient. Medical school has always served to prepare aspiring young physicians for these encounters. The four years of school, residency, the rotations, the board exams -- all training designed to prepare physicians to successfully identify and treat the problems plaguing the patient in the room.

However, the world of medicine extends far beyond the confines of those four walls. Outside the patient room door, there are other actors, such as health care administrators and insurance providers, impacting the delivery of care. And there are also other patients to consider as well -- hundreds or thousands or even millions of them, depending of the scope of the lens through which the delivery of health care is being examined.

The point is, the world of health care is vast and complex. And the questions and problems that arise in trying to effectively and efficiently provide quality care to entire communities or population groups present challenges that extend beyond the lessons learned in human anatomy, biology and the dozens of other subjects covered in medical school and throughout a physician's medical training.

However, a group of University of Michigan medical students aren't going to let that reality prevent them from one day becoming physician leaders. Instead, they're taking it upon themselves to develop and hone the skills necessary to bridge the gap between the clinical and administrative sides of medicine, and they're doing it by running their own medical consulting group -- Med E.C.G.

Founded by four University of Michigan Medical School students in 2017, Med E.C.G. serves to provide pro bono consulting services to community health organizations in the greater Detroit area while also providing medical students the opportunity to expand their skillsets and engage in problem-solving experiences outside of the traditional medical school curriculum. The idea to start Med E.C.G. struck founding member, David Portney, while he was working for a consulting firm in Chicago before starting medical school.

"I always intended to go the medical school, but I decided to spend the first two years of my career consulting," says Portney. "During that time, I was able to work on some health care projects and it became clear to me that there are a lot of big picture things you can focus on in the business and administrative sides of health care. And while I was certain I wanted to practice medicine, the experience helped me realize I also wanted to develop a knowledge base and skillset that would allow me to engage and contribute in a meaningful way to these other areas later in my career."

Fortunately, David didn't need to look far for a creative way to continue developing and applying his consulting skills upon starting medical school.

"While I was in Chicago, I happened to meet some medical students at Northwestern who also had backgrounds in consulting, and they had decided to put their experience to good use by forming their own consulting group, Second Opinions -- that really was the inspiration for Med E.C.G. It seemed like such an ingenious way for students with business consulting skills -- or just those students interested in developing those abilities -- to build and refine a skillset aligned with their long-term career goals in such a way that would also produce some good for the community. I knew that was something I wanted to attempt to do at Michigan."

Upon starting medical school, Portney had little trouble finding other students interested in seeing his idea get off the ground.

"I had a friend in the class above me who also had a consulting background -- she loved the idea and she happened to have a friend in her class who also had past experience in the consulting world and would likely be interested, and that's how Paige VonAchen and Matt Carey joined us."

And finding the fourth founding member was just happenstance.

"I just happened to be chatting with David toward the beginning of the year and it came up," says founding member, Taylor Standiford. "Like David, I was coming into medical school with some prior experience on the administrative side of medicine, which I had really enjoyed. The idea of forming a consulting group sounded like a great way to incorporate those skills into my experience here in medical school."

The group found an initial client in Packard Health -- a community health center serving families in Washtenaw County. Since then, the Med E.C.G. team has more than tripled in size and has completed a variety of projects, from helping a health collaborative set up best practices and implement measurement tools to reduce the impact of diabetes in the local community to providing research and recommendations to a federally-qualified health center considering a move to value-based contracting.

On average, projects take approximately three months to complete and, on any given week, team members can expect to spend two to four hours working on deliverables. However, David and Taylor have found they spend a considerable amount of additional time committed to managing the growing group -- occupied with tasks such as applying for grants, helping sponsor medical school events, and writing a research paper about Med E.C.G.

Now in their second year of medical school and starting their heavy clinical rotations, David and Taylor will temporarily hand over the leadership responsibilities to their older co-founders, Matt and Paige, but the long-term future of Med E.C.G is already being considered by its founders.

"It's important to me that we to start finding people in the classes below us who not only understand and care about the mission of this group, but who are also willing to take over the reins and move things forward after we're gone," says Portney. "Medicine is changing rapidly, and I have no idea how it will look in 15 years, but I do think it will be important that physicians with a clinical background have a seat at the table when higher-level problems are being discussed and decisions are being made. I think Med E.C.G is preparing all of us to potentially one day take a seat at that table, and I think it's critical we try to preserve that opportunity for the students that come after us."

And just as important as playing a role in impacting the future leaders of medicine, Med E.C.G.'s founders want to see that their organization continues to be a source of good work in the community.

"As a medical student, sometimes you feel like you're just taking and taking -- absorbing knowledge, information and idea -- and sometimes I think it can feel like you don't have that many skills to give," says Standiford. "Med E.C.G. has proved to be an opportunity to take an already existing skillset and apply it in a way that produces some good in the community. It feels great to actually be contributing in that way, and I hope Med E.C.G. can continue to provide that sort of value long after David and I are gone."