Emergency medicine subinternship: does a standard clinical experience improve performance outcomes?

Area of Science:

• Medical Education
• Emergency Medicine Training

Background:

• The emergency medicine (EM) subinternship offers varied clinical experiences for senior medical students.
• Standardizing the didactic curriculum is feasible, but controlling the clinical component presents challenges.
• Clinical exposure can be influenced by student interest and faculty guidance.

Purpose of the Study:

• To determine if a requirement of encountering 10 predetermined cases during the EM subinternship improves student general knowledge.
• To assess the impact of a structured clinical experience on objective examination performance.

Main Methods:

• A prospective, nonrandomized, case-controlled study involved assigning students to either a control group (CG) or a test group (TG).
• The TG was mandated to encounter ten specific chief complaints, with all patient encounters logged.
• Knowledge was assessed using a pretest and a 40-question final exam, with statistical analyses comparing group performance.

Main Results:

• Test group (TG) students were significantly more likely to complete the 10 required cases (31.8%) compared to the control group (CG) (6%).
• The TG demonstrated a significantly greater relative improvement in general knowledge exam scores compared to the CG.
• Multivariate analysis indicated that improved performance was not influenced by gender or intended specialty.

Conclusions:

• Requiring EM subinterns to manage patients with specific chief complaints enhances their performance on general knowledge examinations.
• A structured clinical curriculum, focusing on representative cases, is more effective than unguided patient selection for improving EM knowledge.
• This finding supports the implementation of targeted case requirements in medical education.