Impact of Rotation Timing on Emergency Medicine Sub-Internship Course Outcomes

Emergency medicine sub-internships traditionally occur in summer months to facilitate letters of recommendation for residency applications, although it is unknown whether sub-internship timing impacts course outcomes. The purpose of this study was to identify seasonal trends in course outcomes.

This retrospective observational study examined 84 EM-bound medical students during a 4-week EM sub-internship between 2021 and 2024. During the rotation, students received on-shift evaluations graded on a Likert scale from 0 (inadequate) to 4 (outstanding) and completed an online SAEM exam (scored 0-100), both of which contributed to the final course grade. Course outcomes included the number of evaluations, average evaluation score, SAEM score and final course grade. Outcomes were compared between students rotating in May-July (25 students) and August-October (59 students). Analysis was completed in SPSS using independent t-tests, Mann-Whitney U tests and regression analysis to adjust for confounders.

There were no significant differences in outcomes between the May-July and August-October subgroups when comparing average evaluation score (p = 0.11), SAEM score (p = 0.32) and final course score (p = 0.21).

No performance differences were observed between early summer (May-July) and fall (August-October) rotations. These findings suggest that early summer rotations do not offer a significant advantage over fall rotations. Limitations include a single site study. Future research is needed to investigate factors contributing to seasonal variation in sub-internship performance.