Emergency Medicine Clerkship Experiences: A Comparison of Freestanding and Hospital-Based Emergency Departments

Emergency medicine (EM) clerkships are essential in undergraduate medical education, yet the impact of clinical setting-freestanding emergency departments (FSEDs) vs. hospital-based emergency departments (HBEDs)-on students' educational experiences remains understudied.

This study evaluates how these environments influence autonomy, procedural opportunities, and learning preferences.

The authors conducted a survey-based study of medical students who completed EM clerkships between May and December 2023. Students anonymously reported their experiences across FSED and HBED settings. The survey captured demographic characteristics, educational preferences, procedural exposure, and perceived autonomy.

Of 51 eligible students, 39 (76%) responded. Students expressed similar overall preferences for both FSEDs and HBEDs. At FSEDs, students reported greater autonomy (n = 30 [77%]) and more time with attending physicians (n = 22 [56.4%]). HBEDs, in contrast, offered more procedural opportunities (n = 29 [74%]), including trauma care. The most frequently performed procedures were laceration repair (92%), ultrasound (67%), ultrasound-guided intravenous placement, and splinting (31%). Students preferred learning from both attendings and residents. However, resident interaction varied by site, with fewer residents present in FSEDs. Students indicated that each setting contributed uniquely to their learning, with FSEDs allowing greater independence and HBEDs offering higher patient volume and acuity.

Students reported distinct benefits from both settings. FSEDs provided more autonomy and attending interaction and HBEDs enhanced procedural experience and trauma exposure. Incorporating both ED environments into EM clerkships may maximize educational value. Further research should evaluate how setting exposure influences student performance and preparedness for residency.