Clerkship Directors In Emergency Medicine Research Articles

Second- and third-year medical students' clinical encounters in the emergency department.

Experiential learning theory suggests that direct clinical experiences facilitate learning. Previous literature has focused primarily on the experiences of fourth-year medical students. As more students gain early clinical exposure, it is important to understand the types of patients seen by junior students. This study aims to categorize the clinical experiences of early (M2 and M3) students in the emergency department (ED). A retrospective review of the electronic health record of patients seen by M2s and M3s on a 2-week emergency medicine rotation at a single urban academic ED in the Midwest was performed. Data elements extracted included total number of patients seen, Emergency Severity Index (ESI), disposition, and chief complaint. Students were not mandated to see any particular patients. Medical students (248) saw 2994 total patients from 2018 to 2022. The median number of patients seen by each student was 12.0 (range 1-32). Pediatric patients made up 6.5% (n = 194) of total patients. Encounters were primarily ESI 2 or 3, which accounted for 89.4% of all patients (n = 2676). The most encountered complaints were abdominal pain, chest pain, and dyspnea, making up 15.6% (n = 467), 8.7% (n = 260), and 5.5% (n = 165), respectively, of total cases. Obstetrics/gynecology, hematologic, and environmental disorders were the least frequently encountered domains. No students saw all Clerkship Directors in Emergency Medicine (CDEM)-recommended complaints. There is significant variability in the ED encounters of M2s and M3s, with wide ranges of patient volume and presentations. This study provides some evidence that early students may not be meeting CDEM recommendations.

Development and evaluation of a novel knowledge assessment tool for pediatric emergency medicine clerkships.

This study seeks to determine validity evidence for a newly developed multiple-choice examination (MCE) tool to assess retention and application of medical knowledge of students enrolled in a pediatric emergency medicine (PEM) clerkship. A team of PEM physicians created a 110-item MCE covering the range of clinical topics in PEM relevant for medical students. The researchers determined examination content using the report of Clerkship Directors in Emergency Medicine and PEM Interest Group of the Society for Academic Emergency Medicine (SAEM). The authors administered the MCE to fourth-year medical students at the end of their PEM rotation from May 2020 to April 2023 at four institutions and then analyzed the examination using four of Messick's five sources of validity evidence: content, response process, internal structure, and relation to other variables. A total of 158 students took the test. In academic year (AY)20-21, 47 students took the test and scored, on average, 81%. After revision of poor and indeterminate questions, the 111 medical students who took the revised version of the test in AY21-AY23 scored on average 77.3% with a standard deviation of 5.7% with a normal distribution in scores. The revised questions were rated as excellent (10.0%), good (26.4%), fair (34.5%), poor (24.5%), or indeterminate (4.5%) based on test item discrimination. There was a positive correlation between MCE scores and students' clinical evaluations but no correlation between MCE scores and scores that students received on their clinical notes or patient presentations during case conference. This novel PEM clerkship examination is a reliable test of medical knowledge. Future directions involve evaluating consequences of the MCE and offering the test to medical students in a dedicated PEM rotation at the national level.

Away Rotation Applications in Emergency Medicine: Medical Student Behaviors, Outcomes, and Stressors

Completing an emergency medicine (EM) away rotation is integral to matching successfully into an EM residency program. The demand for EM away rotations (ARs) drives students to submit numerous applications without evidence-based recommendations to guide stakeholders on the approach or number to submit. We conducted a survey study of EM-bound fourth-year medical students to gain insight into their AR application experiences, outcomes, and perceptions. We distributed a 40-item questionnaire to EM applicants in Fall 2018 via e-mail through the Clerkship Directors in Emergency Medicine, Council of Residency Directors in EM, and Emergency Medicine Residents' Association listservs. Responses were evaluated using quantitative and qualitative analysis. Primary outcomes were the number of AR applications submitted and AR offers received by students. Secondary outcomes were students' self-assessment of their competitiveness, differences in AR application numbers by degree type, sources of student advising, and student perceptions of the AR application process. There were 253 respondents, consisting of 192 allopathic (MD) and 61 osteopathic (DO) medical students, who met the inclusion criteria, representing about 10% of the applicant pool. On average, students submitted 13.97 applications (95% confidence interval [CI] 11.59-16.35), received 3.25 offers (95% CI 3.01-3.49), and accepted 2.22 offers (95% CI 2.08-2.36). DO candidates submitted twice as many applications as MD candidates while experiencing a similar rate of offers received. Peer influence (n=154, 61%), peer online advising networks (n=83, 33%), and self-assessment (n=114, 45%) were the most often reported causes of increased applications; cost (n=104, 41%) and geographic limitations (n=114, 45%) were the most often reported causes of decreased applications. Open-response analysis revealed frustration with lack of standardization (n=44, 29.5%), insufficient transparency on available positions (n=37, 24.8%), limited communication (n=30, 20.1%), and cost (n=12, 8.1%). This study showed that, as a whole, students received one away rotation offer for every four to five applications submitted. It clarified factors contributing to increased EM away rotation application submissions and associated stressors inherent in the application experience. Our findings offer insights to inform advising recommendations. They also suggest that stakeholders consider standardizing the process and improve communication over spot availability and application status.

Relationship Between Institutional Standardized Letter of Evaluation Global Assessment Ranking Practices, Interviewing Practices, and Medical Student Outcomes

Emergency medicine (EM) program directors rely largely on the standardized letter of evaluation (SLOE) to help determine which applicants to interview in the face of an increasing number of applications. To further characterize the SLOE's role in the EM application process, particularly the global assessment (GA) ranking and its effect on interviewing practices and medical student outcomes, the leaders of EM programs were surveyed regarding their experiences in both generating and utilizing the SLOE. Individuals on the Council of Emergency Medicine Residency Directors (CORD) and Clerkship Directors in Emergency Medicine (CDEM) Academy listservs were anonymously surveyed from March 21-30, 2015, with 18 questions in multiple-choice and fill-in-the-blank formats. There were 99 respondents. Only 39 respondents (39%) reported adhering strictly to SLOE guidelines by evenly placing their students into thirds (top, middle, lower) on the SLOE GA. Most respondents interviewed individuals ranked in the lower third. Programs adhering strictly to ranking guidelines were more likely to interview students in the lower third than those adhering loosely or not at all. There was no relationship between a program's self-reported adherence to the SLOE ranking guidelines and the number of unmatched students in EM during the 2014 and 2015 academic years. Many SLOE writers do not strictly adhere to CORD's SLOE writing guidelines when using the GA ranking, due to the fear of adversely impacting an applicant's ability to successfully match into EM. This calls into question the validity of the SLOE as it is currently used. However, this study suggests that adhering to recommended SLOE ranking guidelines is unlikely to substantially increase the risk that students will fail to match. If more evaluators were to adhere to the guidelines, the SLOE could become the valid evaluation instrument that graduate medical education has long been pursuing.

The National Clinical Assessment Tool for Medical Students in the Emergency Department (NCAT-EM).

IntroductionClinical assessment of medical students in emergency medicine (EM) clerkships is a highly variable process that presents unique challenges and opportunities. Currently, clerkship directors use institution-specific tools with unproven validity and reliability that may or may not address competencies valued most highly in the EM setting. Standardization of assessment practices and development of a common, valid, specialty-specific tool would benefit EM educators and students.MethodsA two-day national consensus conference was held in March 2016 in the Clerkship Directors in Emergency Medicine (CDEM) track at the Council of Residency Directors in Emergency Medicine (CORD) Academic Assembly in Nashville, TN. The goal of this conference was to standardize assessment practices and to create a national clinical assessment tool for use in EM clerkships across the country. Conference leaders synthesized the literature, articulated major themes and questions pertinent to clinical assessment of students in EM, clarified the issues, and outlined the consensus-building process prior to consensus-building activities.ResultsThe first day of the conference was dedicated to developing consensus on these key themes in clinical assessment. The second day of the conference was dedicated to discussing and voting on proposed domains to be included in the national clinical assessment tool. A modified Delphi process was initiated after the conference to reconcile questions and items that did not reach an a priori level of consensus.ConclusionThe final tool, the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM) is presented here.

Creating a contemporary clerkship curriculum: the flipped classroom model in emergency medicine.

BackgroundThe teaching modality of “flipping the classroom” has garnered recent attention in medical education. In this model, the lecture and homework components are reversed. The flipped classroom lends itself to more interaction in “class” and theoretically improved clinical decision-making. Data is lacking for this model for students in emergency medicine clerkships. We trialed the flipped classroom in our fourth-year student clerkship. Our aim was to learn student and faculty facilitator perceptions of the experience, as it has not been done previously in this setting. We evaluated this in two ways: (1) participant perception of the experience and (2) facilitator (EM physician educator) perception of student preparation, participation, and knowledge synthesis.MethodsWith permission from its creators, we utilized an online video series derived from the Clerkship Directors in Emergency Medicine. Students were provided the link to these 1 week prior to the classroom experience as the “homework.” We developed patient cases generated from the videos that we discussed during class in small-group format. Afterward, students were surveyed about the experience using four-point Likert items and free-text comments and also were evaluated by the facilitator on a nine-point scale.ResultsForty-six clerkship students participated. Students deemed the online modules useful at 2.9 (95 % CI 2.7–3.2). Further, they reported the in-class discussion to be of high value at 3.9 (95 % CI 3.8–4.0), much preferred the flipped classroom to traditional lecturing at 3.8 (95 % CI 3.6–3.9), and rated the overall experience highly at 3.8 (95 % CI 3.7–3.9). Based on preparation, participation, and knowledge synthesis, the facilitator judged participants favorably at 7.4 (95 % CI 7.0–7.8). Students commented that the interactivity, discussion, and medical decision-making were advantages of this format.ConclusionsStudents found high value in the flipped classroom and prefer it to traditional lecturing, citing interactivity and discussion as the main reasons. The facilitator also viewed that the students were not only well prepared for the flipped classroom but that they also actively participated in and synthesized knowledge adequately during this experience. This study supports the use of the flipped classroom for EM clerkship students as a valuable, preferable teaching technique.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-016-0123-6) contains supplementary material, which is available to authorized users.

Consensus development of a pediatric emergency medicine clerkship curriculum.

IntroductionAs emergency medicine (EM) has become a more prominent feature in the clinical years of medical school training, national EM clerkship curricula have been published to address the need to standardize students’ experiences in the field. However, current national student curricula in EM do not include core pediatric emergency medicine (PEM) concepts.MethodsA workgroup was formed by the Clerkship Directors in Emergency Medicine and the Pediatric Interest Group of the Society of Academic Emergency Medicine to develop a consensus on the content to be covered in EM and PEM student courses.ResultsThe consensus is presented with the goal of outlining principles of pediatric emergency care and prioritizing students’ exposure to the most common and life-threatening illnesses and injuries.ConclusionThis consensus curriculum can serve as a guide to directors of PEM and EM courses to optimize PEM knowledge and skills education.

Medical Student Education in Emergency Medicine: Do Students Meet the National Standards for Clinical Encounters of Selected Core Conditions?

BackgroundEstablishing a core curriculum for undergraduate Emergency Medicine (EM) education is crucial to development of the specialty. The Clerkship Directors in Emergency Medicine (CDEM) National Curriculum Task Force recommended that all students in a 4th-year EM clerkship be exposed to 10 emergent clinical conditions. ObjectivesTo evaluate the feasibility of encountering recommended core conditions in a clinical setting during a 4th-year EM clerkship. MethodsStudents from three institutions participated in this ongoing, prospective observation study. Students' patient logs were collected during 4-week EM clerkships between July 2011 and June 2012. De-identified logs were reviewed and the number of patient encounters for each of the CDEM-identified emergent conditions was recorded. The percentage of students who saw each of the core complaints was calculated, as was the average number of core complaints seen by each. ResultsData from 130 students at three institutions were captured; 15.4% of students saw all 10 conditions during their rotation, and 76.9% saw at least eight. The average number of conditions seen per student was 8.4 (range of 7.0–8.6). The percentage of students who saw each condition varied, ranging from 100% (chest pain and abdominal pain) to 31% (cardiac arrest). ConclusionsMost students do not encounter all 10 conditions during patient encounters throughout a 4-week EM rotation, although most have exposure to at least eight. Certain conditions are far less likely than others to be encountered, and may need to be taught in a nonclinical setting.

Creation and Implementation of a National Emergency Medicine Fourth-Year Student Examination

BackgroundA National Board of Medical Examiners examination does not exist for Emergency Medicine (EM) students. To fill this void, the Clerkship Directors in Emergency Medicine tasked a committee with development of an examination for 4th-year (M4) EM students, based on a published syllabus, and consisting of questions written according to published question-writing guidelines. Study ObjectivesDescribe examination development and statistics at 9 months. MethodsThe committee reviewed an existing EM student question database at www.saemtests.org for statistical performance, compliance with item-writing guidelines, and topic inclusion within the published EM M4 syllabus. For syllabus topics without existing questions, committee members wrote new items. LXR 6.0 software (Applied Measurement Professionals, Inc., Georgetown, SC) was used for examination administration. Data gathered included numbers of examinations completed, mean scores with SD, and point biserial correlation (rpb). ResultsOf the 553 questions assessed, 157 questions met the stated criteria, and 37 were included in the examination. Thirteen new questions were written by committee members to cover all curriculum topics. The National EM M4 Examination was released online August 1, 2011. Nine months later, the examination had been completed 1642 times by students from 27 clerkships. Mean score was 79.69% (SD 3.89). Individual question difficulties ranged from 26% to 99%. Question rpbs ranged from 0.067 to 0.353, mean 0.213 (SD 0.066). ConclusionsA national group of EM educators developed an examination to assess a published clerkship syllabus. The examination contains questions written according to published item-writing guidelines, and exhibits content validity, appropriate difficulty levels, and adequate question discriminatory ability.

Guidebook for Clerkship Directors. 4th ed

Guidebook for Clerkship Directors. 4th ed

Journal Watch From ACE (Alliance for Clinical Education): Annual Review of Medical Education Articles in Emergency Medicine, 2010–2011

Teaching and Learning in Medicine, 25(2), 178–182 C 2013, Taylor & Francis Group, LLC Copyright ! ISSN: 1040-1334 print / 1532-8015 online DOI: 10.1080/10401334.2013.772003 Journal Watch From ACE (Alliance for Clinical Education): Annual Review of Medical Education Articles in Emergency Medicine, 2010–2011 Paul Y. Ko Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York, USA Downloaded by [UPSTATE Medical University Health Sciences Library] at 07:22 26 March 2013 Aaron W. Bernard The Ohio State University, Department of Emergency Medicine, Columbus, Ohio, USA Stacey L. Poznanski Department of Emergency Medicine, Wright State University, Kettering, Ohio, USA Robert Cooney Department of Emergency Medicine, Conemaugh Health System, Johnstown, Pennsylvania, USA Sorabh Khandelwal Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA Michelle Lin Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA This review, sponsored by the Alliance for Clinical Educa- tion, highlights selected medical education articles published in Emergency Medicine journals typically not read by clinician- educators in other specialties. The authors are members of the Clerkship Directors in Emergency Medicine. A literature search was conducted using PubMed using the subject terms Medical Students, Internship and Residency, Clin- ical Clerkship, Medical Education, Undergraduate Medical Education, Graduate Medical Education, Continuing Medi- cal Education, and then combined with the term Emergency Medicine. The search was limited to full, English language original publications published between January 1, 2010, and December 31, 2011. We excluded the following journals, which have medical education contributions that are read across spe- cialties: Academic Medicine, British Medical Journal, Lancet, Medical Education, Medical Teacher, Journal of the American Medical Association, New England Journal of Medicine, and Teaching and Learning in Medicine. Two independent searches were performed by Dr. Ko and Dr. Poznanski and a total of 136 articles met the aforementioned criteria. The 136 articles were reviewed by all six authors for poten- tial inclusion in this review. Fifty-six articles were chosen for Correspondence may be sent to Paul Y. Ko, 550 East Genesee Street #103, Syracuse, NY 13202, USA. E-mail: kop@upstate.edu secondary formal review based on quality of study and poten- tial interest to educators outside Emergency Medicine. These articles were broken up into three groups, and two authors in- dependently reviewed each article. Each article was critiqued and scored on study design, data analysis, outcome measure- ments, relevance, and innovation, with weight given to the last two items. Emphasis on generalizability and potential interest to educators of other disciplines was noted by the reviewers. After this review and consensus discussions, 12 articles that were thought to highlight the most relevant and rigorous studies focusing on a wide spectrum of medical education topics were selected for inclusion in this review. PROGRAM/CURRICULUM DEVELOPMENT 1. Friedman S, Sayers B, Lazio M, Friedman S, Gisondi MA. Curriculum design of a case-based knowledge translation shift for Emergency Medicine residents. Academic Emergency Medicine 2010;17:S42–8. Despite the abundance of evidence available to clinicians, the ability to transfer that evidence-based information to the practice environment (i.e., knowledge translation) is inconsis- tently taught and applied. In this prospective, observational, cohort study involving emergency medicine residents, the au- thors design, implement, and evaluate a case-based knowl- edge translation curriculum that enables a resident to practice

A Novel Approach to Incorporating Evidence‐based Medicine Into an Emergency Medicine Clerkship

Despite the growing emphasis of evidence-based medicine (EBM) in the medical school curriculum, and the recognition of EBM's role in the practice of emergency medicine (EM), there are no current guidelines on how to teach EBM to fourth-year medical students during their EM rotations. The goal was to create a unique EM clerkship curriculum that teaches students to incorporate EBM into their clinical decision-making and complies with the core curriculum recommendations of the Clerkship Directors in Emergency Medicine (CDEM). Prior to a scheduled, case-based small group discussion, students are provided with a clinically relevant question to investigate. Case discussions are led by EM faculty with each case highlighting a core EM topic developed by CDEM. During the case discussion, the assigned clinical question is addressed and a plan of care is presented based on the tenets of EBM. Faculty members function as moderators for these discussions and provide individual feedback regarding search strategies, appraisal of the literature findings, and applicability to the patient population. This multifaceted approach to EBM through the incorporation of individual student literature searches, clinical vignettes, small group discussion with consensus building, and faculty moderation with timely feedback is an innovative educational technique. Future educational research must explore the efficacy of this curriculum and whether or not the model produces greater long-term understanding of EBM by students and if similar curricula can be executed at other institutions. The authors have developed a novel fourth-year EM clerkship curriculum that integrates EBM through the use of a highly interactive, faculty-led, small group-learning environment that encourages students to develop the necessary skills to integrate EBM into their clinical practice.

Developing a Third‐year Emergency Medicine Medical Student Curriculum: A Syllabus of Content

Emergency medicine (EM) educators have published several curricular guides designed for medical student rotations and experiences. These guides primarily provided brief overviews of opportunities to incorporate EM into all 4 years of the medical student curriculum, with one specific to the fourth year. However, there are no published guidelines specific to third-year medical students rotating in EM. Given the differences between third-year and fourth-year students in terms of clinical experience, knowledge, and skills, the Clerkship Directors in Emergency Medicine (CDEM) established the Third-year EM Medical Student Curriculum Work Group to create a third-year curriculum. The work group began this process by developing consensus-based recommendations for the content of a third-year medical student EM rotation, which are presented in this syllabus.

Simulation in Medical Student Education: Survey of Clerkship Directors in Emergency Medicine

IntroductionThe objective of this study is to identify (1) the current role of simulation in medical student emergency medicine (EM) education; (2) the challenges to initiating and sustaining simulation-based programs; and (3) educational advances to meet these challenges.MethodsWe solicited members of the Clerkship Directors in Emergency Medicine (CDEM) e-mail list to complete a Web-based survey addressing the use of simulation in both EM clerkships and preclinical EM curricula. Survey elements addressed the nature of the undergraduate EM clerkship and utilization of simulation, types of technology, and barriers to increased use in each setting.ResultsCDEM members representing 60 EM programs on the list (80%) responded. Sixty-seven percent of EM clerkships are in the fourth year of medical school only and 45% are required. Fewer than 25% of clerkship core curriculum hours incorporate simulation. The simulation modalities used most frequently were high-fidelity models (79%), task trainers (55%), and low-fidelity models (30%). Respondents identified limited faculty time (88.7%) and clerkship hours (47.2%) as the main barriers to implementing simulation training in EM clerkships. Financial resources, faculty time, and the volume of students were the main barriers to additional simulation in preclinical years.ConclusionA focused, stepwise application of simulation to medical student EM curricula can help optimize the ratio of student benefit to faculty time. Limited time in the curriculum can be addressed by replacing existing material with simulation-based modules for those subjects better suited to simulation. Faculty can use hybrid approaches in the preclinical years to combine simulation with classroom settings for either small or large groups to more actively engage learners while minimizing identified barriers.

431: “Resident as Teacher” Programs In Mandatory Emergency Medicine Clerkships

431: “Resident as Teacher” Programs In Mandatory Emergency Medicine Clerkships

Emergency Medicine Clerkship Curriculum: An Update and Revision

In 2006, the latest version of a national curriculum for the fourth-year emergency medicine (EM) clerkship was published. Over the past several years, that curriculum has been implemented across multiple clerkships. The previous curriculum was found to be too long and detailed to cover in 4 weeks. As well, updates to the Liaison Committee on Medical Education (LCME)'s form and function document, which guides the structure of a clerkship, have occurred. Combining experience, updated guidelines, and the collective wisdom of members of the national organization of the Clerkship Directors in Emergency Medicine (CDEM), an update and revision of the fourth-year EM clerkship educational syllabi has been developed.

Overcrowding: Harming the Patients of Tomorrow?

It is 3 AM on August 1st, 2018, in a busy hospital when a 47-year-old male presents with chest pain. The emergency physician on duty, who is a new residency graduate, performs a history and physical, orders an ECG, chest x-ray, and blood work. After reviewing the data, the patient is given aspirin, nitroglycerin, and heparin and admitted to observation for a rule-out with serial enzymes. At 7 AM, the patient’s chest pain worsens and he suffers a cardiac arrest. An autopsy reveals cardiac tamponade and a large thoracic aortic dissection.

Clerkship Directors in Emergency Medicine: Statement of Purpose

The Academy of Clerkship Directors in Emergency Medicine (CDEM) provides a forum for the collaborative exchange of ideas among emergency medicine (EM) medical student educators, a platform for the advancement of education, research, and faculty development, and establishes for the first time a national voice for undergraduate medical education within our specialty. CDEM plans to take a leading role in providing medical student educators with additional educational resources and opportunities for faculty development and networking. CDEM will work to foster the professional growth and development of undergraduate medical educators within our specialty. The advancement of undergraduate education within our specialty and beyond will come primarily from the support, hard work, and dedication of the educators. To accomplish our goals, at the departmental, medical school, and national level, we must come together to further promote our specialty across the spectrum of undergraduate medical education. The first step has already been taken with the formation of the Academy of CDEM.