Political and budget issues associated with educating medical students

Unfortunately for medical educators, medical student clerkships in emergency medicine (EM) do not occur in isolation from the key institutional issues of organizational politics and resource support. This article discusses some of the political and resource issues in proposing and obtaining support for a mandatory EM student clerkship. Political issues of importance include: 1) securing intradepartmental support from all faculty and the chair for the priority and teaching commitment of a mandatory clerkship; 2) strategizing the different steps and their sequencing for achieving clerkship approval, including cultivation of key supporters, content of a clerkship proposal, and resource support needs; 3) identifying and collecting data from existing EM teaching efforts that will support a mandatory clerkship proposal; 4) establishing a connection between the overall educational outcome objectives for students of the school and the educational outcomes for students taking the EM clerkship; and 5) developing solutions to logistic issues in clerkship implementation (availability of an adequate number of teaching sites; establishment of equivalence of educational experiences across all sites). A list of resources for a mandatory clerkship, an "ideal" budget, and potential rationales to advocate for resource support from specific funding sources are included.