Emergency medicine subinternship: can we provide a standard clinical experience?

Medical students have varied experiences on the emergency medicine (EM) subinternship. Didactic curricula can be standardized.

To determine if uniformity in clinical curricula is possible by assessing whether students can see patients with certain chief complaints (CC).

Prospective interventional analysis at a public teaching hospital. Control group (CG) students saw patients of their choice and recorded encounters in logbooks. Test group (TG) students were asked to see at least one patient with: orthopedic injury (OR); asthma exacerbation (AE); acute coronary syndrome (ACS); traumatic injury (TR); laceration (LAC); or diabetic ketoacidosis (DKA). TG students prospectively recorded these patients on a separate logbook page. Logbooks were reviewed by two investigators to determine if a patient with each diagnosis was seen. Chi-square analysis tested for differences in sample proportions between TG and CG. Multivariate analyses controlled for TG, specialty choice, and gender. p < 0.05 represented statistical significance.

One hundred fifty (88 TG; 62 CG) students participated. Differences existed between TG and CG in the proportion of students who saw a patient with each CC: OR: 93% TG, 69% CG (p < 0.0001); AE: 86% TG, 63% CG (p < 0.0008); ACS: 97% TG, 58% CG (p < 0.0001); TR: 97% TG, 58% CG (p < 0.0001); LAC: 98% TG, 89% CG (p < 0.0220); DKA: 68% TG, 47% CG (p < 0.0086). Logistic regressions explaining the probability of seeing each CC showed the variable controlling for TG was positive and significant for 5 CCs: p = 0.0013 (OR); 0.0038 (AE); 0.0001 (ACS); 0.0001 (TR); 0.0229 (DKA). No difference was found for LAC: p = 0.0570.

Students can be directed to see patients with particular CCs. TG students saw more patients with certain CCs than CG students, p < 0.0001. This intervention can help educators provide a well-rounded, uniform clinical EM experience.