The Emergency Medicine Subinternship--an educator's guide to planning and administration

The senior year provides an excellent opportunity for medical students to experience the specialty of emergency medicine for career exploration and skill development. This educational experience can provide the medical school with the means to meet the Liaison Committee on Medical Education recommendation that all graduating students should be capable of handling emergencies. The senior rotation may be a mandatory or elective experience. It is in the emergency department that students can gain experience in evaluating the undifferentiated patient and may refine their history and physical examination skills. They have the chance to become adept at rapid decision making in the diagnosis and stabilization of patients. This paper outlines the components of a typical four-week rotation, such as the orientation session, the didactic program, the clinical experience, the evaluation of students, the faculty, and the educational experience. Strategies for implementing both didactic and clinical components of the curriculum are provided. The managerial role of the clerkship director is introduced. Suggestions for assuming administrative and educational responsibility for an existing course are made. A guide to the development and implementation of a new course is described, in which the course objectives and prerequisites must be set, the core didactic curriculum formulated, the clinical experience defined, and a system of evaluation and feedback developed. Students generally enjoy their emergency medicine experience as it is often their first opportunity to assume primary responsibility for patient care. Clerkship directors can develop their leadership skills in managing a major educational component of the senior year that may prove beneficial in developing a career in the field of medical education.