Article review: Standardizing the EM clerkship patient encounter experience

As a medical student, do you remember your EM clerkship experience and whether you saw a wide variety of patient chief complaints? Did your fellow medical student on the EM clerkship rotation, who was going into Orthopedics, seem to only see patients with orthopedic complaints?


In a study in Academic EM in 2008 at Harbor-UCLA Medical Center, medical students were provided a list of 10 chief complaints which they had to see during their 4-week rotation. These chief complaints were:

1. Abdominal pain
2. Acute coronary syndrome
3. Asthma
4. Diabetic ketoacidosis / hyperglycemia
5. Headache
6. Laceration
7. Orthopedic injury
8. Pediatric fever
9. Traumatic injury
10. Vaginal bleeding

When I last spoke with Dr. Wendy Coates (one of the authors), this study arose because she found that medical students, if left on their own, will NOT see a variety of patients during the EM clerkship rotation.

This was a prospective, non-randomized, case-control study. The control group (n=18) included students who saw whichever patients they desired during the EM clerkship rotation. The test group (n=24) included students who were assigned to see each of the 10 listed chief complaints during rotation.

Results: Using a difference in means analysis, the test group students showed greater exam score improvement (post-test score minus pre-test score), compared to the control students. What was interesting was this exam tested a broad range of topics including and beyond the 10 assigned chief complaints.


Some ideas
After reading this article, I find myself thinking about whether a similar approach might be applied in other settings.

1. I think this would be terrific idea for interns (PGY-1 residents) on the EM rotation. Many interns from a variety of departments rotate through the Emergency Department to gain a broad experience in managing acute medical conditions. Although I find that most interns are open to seeing a variety of chief complaints, several naturally gravitate towards only seeing patients with complaints which are directly relevant to their specialty. This checklist of chief complaints would encourage interns to gain a more balanced and broad EM knowledge base.
2. Another idea -- there could be a completely different checklist of chief complaints for students who are rotating on their second EM rotation. These chief complaints could include more advanced topics such as: eye complaint, acute back pain, drug of abuse, and seizure/stroke.

Do you have any ideas or thoughts?

Reference:
Lampe CJ, Coates WC, Gill AM. Emergency medicine subinternship: does a standard clinical experience improve performance outcomes? Acad Emerg Med. 2008 Jan;15(1):82-5.