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:
Abdominal pain- Acute coronary syndrome
- Asthma
- Diabetic ketoacidosis / hyperglycemia
- Headache
- Laceration
- Orthopedic injury
- Pediatric fever
- Traumatic injury
- Vaginal bleeding
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.
- 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.
- 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.