Internal Medicine Core Clerkships Experience With Core Problem Lists: Results From a National Survey of Clerkship Directors in Internal Medicine

Background: The Liaison Committee on Medical Education (LCME) requires clinical clerkships in North American Medical Schools to define and monitor core problems and clinical conditions for medical students and adjust the clerkships to ensure that all students meet those objectives at all instructional sites. Clinical clerkships usually use medical student generated logbooks to meet these requirements. It is not clear what clinical clerkship directors are doing to meet these standards. Purpose: To determine how internal medicine clerkship directors develop problem lists, whether and how they verify student problem list entry, and how missed core problems are covered. Methods: The Clerkship Directors in Internal Medicine (CDIM) organization conducts an annual survey of its institutional members (one member per medical school). In 2007, 75% of North American medical schools (82 of 110) responded to the survey, which included questions on core problem lists and medical student logbooks. Results: Ninety-four percent of responding medical schools had a core problem list for the core internal medicine clerkship. Most schools used an electronic logbook and verified student exposure to core problems (76%). The clerkship director usually did the verification (63%). Clerkships offered a variety of options to remedy lack of exposure to core problems and usually offered more than one option. Conclusions: Clerkship directors in internal medicine develop, verify, and ensure exposure to core problems in internal medicine. Most clerkship directors used the CDIM recommended core problem list as a basis for their local core problem list. Emerging computer-assisted learning options may simplify clerkship adjustments for lack of exposure to core problems. It appears that clerkship directors are using logbooks appropriately to meet the LCME charge to monitor core problems and clinical conditions.     

Advanced Opportunities for Student Education in Emergency Medicine

Many medical students are excited about emergency medicine (EM) following a standard clerkship and seek out additional learning opportunities. An advanced EM elective may accomplish several educational goals, including development of clinical skills in evaluating the undifferentiated patient, broader exploration of the field of EM, and more focused study of one particular aspect of EM. Previously cited examples include pediatric EM, medical toxicology, occupational medicine, sports medicine, and EM research. Numerous other EM specialty courses for senior medical students are emerging, as reflected in the “Undergraduate Rotations” listings on the Society for Academic Emergency Medicine. A few examples drawn from the list include emergency ultrasound, international EM, wilderness medicine, disaster medicine, geriatric EM, and hyperbaric medicine. Educators aspiring to develop, or in the process of developing, an advanced EM elective may benefit from a brief overview of necessary course considerations, including didactic format, the clinical role of the medical student in the emergency department, and involvement with patient procedures. Suggestions are made regarding additional educational opportunities, including follow‐up of patients seen in the emergency department and development of an emergency department radiology case file. This article also addresses several related concerns, including suggested prerequisites, administration and cost considerations, appropriate didactic topics, and methods for evaluating students. Several EM subspecialty areas, namely pediatric EM, medical toxicology, and out‐of‐hospital care, are specifically discussed. Formal advanced cardiac life support training is also often included in an advanced EM elective and is briefly discussed. The overall intent of this article is to provide medical student educators with resources and ideas to assist them in developing a unique advanced EM elective.     

An Educator''s Guide to Teaching Emergency Medicine to Medical Students

There is a need for every medical school graduate to handle emergencies as they arise in the daily practice of medicine. Emergency medicine (EM) educators are in a unique position to provide students with basic life support skills, guidance in assessing the undifferentiated patient, and exposure to the specialty of EM during all years of medical school. Emergency physicians can become involved in a variety of education experiences that can supplement the preclinical curriculum and provide access to our specialty at an early stage. A well-designed course in the senior year allows students to develop critical thinking and patient management skills that are necessary for any medical career path. It can ensure that all medical students are exposed to the skills essential for evaluating and stabilizing the acutely ill patient. To implement this type of course, learning objectives and evaluation methods must be set when the curriculum is developed. An effective course combines didactic and clinical components that draw on the strengths of the teaching institution and faculty of the department. A structured clerkship orientation session and system for feedback to students are essential in nurturing the development of student learners. This article provides an approach to assist the medical student clerkship director in planning and implementing EM education experiences for students at all levels of training, with an emphasis on the senior-year rotation.     

Integrating emergency medicine principles and experience throughout the medical school curriculum: why and how

The management of acutely ill and injured patients is an essential component of medical student education, yet the formal integration of emergency medicine (EM) into the medical school curriculum has progressed slowly since the inception of the specialty. Medical student interest and the number of resident positions in the National Resident Matching Program are higher than any time in the past, yet students often find access to EM faculty and clinical experience limited to a fourth-year rotation. Incorporating EM into all years of the undergraduate medical student curriculum can offer unique educational experiences and enhance exposure to the necessary and recommended knowledge and skills students must attain prior to graduation. Academic emergency physicians (EPs) should advocate our specialty's importance in their medical school curricula using a proactive approach and actively involve themselves in medical student education at all stages of training. The goals of this article are to describe several approaches for EM faculty to expand medical student exposure to the specialty and enhance student experiences in the core principles of EM throughout the undergraduate medical curriculum.     

Emergency Medicine Education and Health Care Disparities

Education is the means by which learning occurs and, thereby, behavior is changed. One means of improving health care disparities is changing the behavior and understanding of key personnel in academic health centers. These individuals influence policy and procedure, design and evaluate health systems, and define curricular standards for graduate and undergraduate medical education. Emergency medicine provides many opportunities to educate at all levels, including faculty, residents, and students. In addition to our responsibilities in educating emergency medicine residents, the emergency department also provides an ideal learning environment for medical students and other health care providers. The broad issue of disparities in emergency health care may be approached from a variety of directions. The Consensus Group on Education chose to focus on cultural competency education at several levels as a means of tangibly changing its status for both the immediate and long terms.     

Emergency Medicine in Undergraduate Education

Abstract. Society has a right to expect that all physicians possess basic knowledge of emergency care and the skills to manage acute problems. Competency in the care of acutely ill and injured patients is one of the fundamental exit goals of most medical schools as mandated by the Liaison Committee on Medical Education. Several groups have called for strengthening the general components of undergraduate medical education, and surveys during the early years of the development of the field of emergency medicine (EM) showed that only a small percentage of schools required significant education in EM. This paper defines the goals and objectives of undergraduate EM education in order to help guide the development of curricular offerings as the role of EM in undergraduate medical school education increases. This paper was developed by the SAEM Education Committee and presents this committee's beliefs on what all graduating medical students should know about assessment and treatment of acutely sick and injured patients. It also suggests methods by which acquisition of this information can occur in medical school education.     

Emergency Medicine Interest Group Curriculum: Faculty and Preclinical Student Opinions Differ in a Formal Needs Assessment

Background: Medical students and Emergency medicine (EM) faculty may have differing opinions on the ideal curriculum during the preclinical years. Objectives: To assess the perceived needs of preclinical medical students exploring EM and compare them with those of EM faculty regarding appropriate educational interventions. Methods: A survey instrument listing 15 workshops related to EM was administered to preclinical medical students in our Emergency Medicine Interest Group (EMIG), and to EM faculty. Respondents graded the perceived utility of each workshop offered at our medical school and those identified via a web search for EMIG. No recommendations for EMIG curriculum were identified through PubMed. Fisher's exact tests were computed using SPSS (SPSS Inc., Chicago, IL) with α = 0.05. Results: There were 48 medical students and 15 faculty members who completed the survey. Students strongly desired workshops in suturing (48/48; 100%), splinting (47/48; 97.9%), and basic electrocardiogram (ECG) interpretation (47/48; 97.9%). Least desired topics were history of EM (16/48; 33.3%), getting involved in EM organizations (20/48; 41.7%), and wellness (21/48; 43.8%). Women chose the domestic violence workshop more than men (p = 0.036). Faculty strongly supported workshops in conducting focused history and physical examination (14/15; 93.3%), the specialty of EM (14/15; 93.3%), and basic ECG interpretation (12/15; 80.0%). The lowest rated faculty preferences were ultrasound (5/15; 33.3%), history of EM (7/15; 46.7%), and emergency radiology (7/15; 46.7%). Conclusions: Preclinical students and faculty opinions of important educational workshops differed. Faculty favored the approach to the undifferentiated patient and an introduction to the specialty, whereas students preferred hands-on workshops. Both groups agreed that basic ECG interpretation was useful. These data may be useful for designing an educational program that is interesting to preclinical students while still meeting the needs as perceived by medical student educators.     

Medical Student Career Advice Related to Emergency Medicine

Objective: To describe the advisors and the advice given to residency candidate interviewees interested in specializing in emergency medicine (EM).
Methods: All interviewees at a university-based EM residency program were surveyed. Data were collected anonymously and included demographic information, characteristics of each applicant's medical school, career advice by non-EM faculty, and access to advisors who are residency-trained in and practicing EM.
Results: Of 114 interviewees, 104 (91%) completed the survey. Only 45% of the respondents reported they were assigned an emergency physician (EP) advisor by their school, and 38% sought advice informally from an EP. Of those students receiving advice from an EP, 70% reported their advisor was residency-trained in EM. Most (57%) respondents reported receiving negative advice concerning a career in EM from non-EM medical school faculty. Of the 59 students reporting negative advice, 18 (31%) received negative comments from non-EM residency program directors, 23 (39%) from non-EM department chairs, and 4 (7%) from medical school deans. The presence of a residency training program increased the chances of a student's being assigned an EP advisor, but neither an EP advisor nor the departmental status of EM within the students' institutions was associated with receipt of negative advice.
Conclusions: Students considering specializing in EM often receive negative advice or have no assigned EP advisor. These factors may adversely affect entry into the field of EM.     

Promoting Diversity in Emergency Medicine: Summary Recommendations from the 2008 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly Diversity Workgroup

Although the U.S. population continues to become more diverse, ethnic and racial health care disparities persist. The benefits of a diverse medical workforce have been well described, but the percentage of emergency medicine (EM) residents from underrepresented groups (URGs) is small and has not significantly increased over the past 10 years. The Council of Emergency Medicine Resident Directors (CORD) requested that a panel of CORD members review the current state of ethnic and racial diversity in EM training programs. The objective of the discussion was to develop strategies to help EM residency programs examine and improve diversity in their respective institutions. Specific recommendations focus on URG applicant selection and recruitment strategies, cultural competence curriculum development, involvement of URG faculty, and the availability of institutional and national resources to improve and maintain diversity in EM training programs.     

International Emergency Medicine and the Role for Academic Emergency Medicine

International emergency medicine continues to grow and expand. There are now more than 30 countries that recognize emergency medicine as a specialty. As the field continues to develop, many physicians are reaching across borders and working with their colleagues to improve patient care, education, and research. The future growth and success of the specialty are based on several key components. These include faculty development (because this is the key driver of education), research, and curriculum development. Each country knows what resources it has and how best to utilize them. Countries that are developing the specialty can seek consultation from successful countries and develop their academic and community practice of emergency medicine. There are many resources available to these countries, including distance learning and access to medical journals via the Internet; international exchanges by faculty, residents, and medical students; and physicians who are in fellowship training programs. International research efforts require more support and effort to be successful. This report discusses some of the advantages and hurdles to such research efforts. Physicians have a responsibility to help one another succeed. It is the hope of the authors that many more emergency physicians will lend their skills to further global development of the specialty.     

Pediatric Emergency Medicine Education in Emergency Medicine Training Programs

BACKGROUND: The educational goal of emergency medicine (EM) programs has been to prepare its graduates to provide care for a diverse range of patients and presentations, including pediatric patients. OBJECTIVE: To evaluate the methods used to teach pediatric emergency medicine (PEM) to EM residents. METHODS: A written questionnaire was distributed to 118 EM programs. Demographic data were requested concerning the type of residency program, number of residents, required pediatric rotations, elective pediatric rotations, type of hospital and settings in which pediatric patients are seen, and procedures performed. Information was also requested on the educational methods used, proctoring EM received, and any formal curriculum used. RESULTS: Ninety-four percent (111/118) of the programs responded, with 80% of surveys completed by the residency director. Proctoring was primarily performed by PEM attendings and general EM attendings. Formal means of PEM education most often included the EM core curriculum (94%), journal club (95%), EM grand rounds (94%), and EM morbidity and mortality (M&M) conference (91%). Rotations and electives most often included the pediatric intensive care unit (PICU) and the emergency department (ED) (general and pediatric). CONCLUSIONS: Emergency medicine residents are exposed to PEM primarily by rotating through a general ED, the PED, and the PICU, being proctored by PEM and EM attendings and attending EM lectures and EM M&M conferences. Areas that may merit further attention for pediatric emergency training include experience in areas of neonatal resuscitation, pediatric M&M, and specific pediatric electives. This survey highlights the need to describe current educational strategies as a first step to assess perceived effectiveness.     

Setting the Educational Agenda and Curriculum for Error Prevention in Emergency Medicine

Graduate and postgraduate medical education currently teaches safety in patient care by instilling a deep sense of personal responsibility in student practitioners. To increase safety, medical education will have to begin to introduce new concepts from the "safety sciences," without losing the advantages that the values of commitment and responsibility have gained. There are two related educational goals. First, we in emergency medicine (EM) must develop a group of safety-educated practitioners who can understand and implement safe practice innovations in their clinical settings, and will be instrumental in changing our professional culture. Second, EM must develop a group of teachers and researchers who can begin to deeply understand how safety is maintained in emergency care, develop solutions that will work in emergency department settings, and pass on those insights and innovations. The specifics of what should be taught are outlined briefly. Work is currently ongoing to identify more specifically the core content that should be included in educational programs on patient safety in emergency care. Finally, careful attention will have to be paid to the way in which these principles are taught. It seems unlikely that a series of readings and didactic lectures alone will be effective. The analysis of meaningful cases, perhaps supplemented by high-fidelity simulation, seems to hold promise for more successful education in patient safety.     

Proceedings of the 2007 Annual Meeting of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP)

The 33rd Annual Meeting of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) was held June 21 to 23, 2007, in Park City, Utah. Plenary sessions, workshops, and posters covered a wide range of educational topics, including Liaison Committee on Medical Education (LCME) issues, culture and stigma in medical education, and innovative media.

Dr. Robert Eaglen, the interim secretary for the LCME, gave the keynote address: “Modern Medical Education through the LCME Lens,” which highlighted clerkship directors' responsibilities in the accreditation process such as ensuring comparability and uniform criteria for student clinical experiences, equivalent cross-site evaluations, preparing residents for their instructional roles and providing timely mid- and final clerkship feedback. Dr. Ruth Lamdan, chair of the ADMSEP Task Force on LCME ED-2, presented “Results of ED-2 Adherence in 10 Medical Schools” and discussed the challenges of uniformity in data collection and remediation strategies for core topics. The group found that uniformity in collection efforts was limited because of different patient encounter documentation systems utilized and that remediation strategies vary greatly for students who had not encountered specified diagnoses, from case discussions and videos to team-based learning experiences to arranging an exposure at an additional clinical site. Hendry Ton, from University of California, Davis, presented a developmental approach to Cultural Competence, sharing strategies for addressing resistance to acknowledging bias and the impact of culture on health care in medical education.

The six abstracts in these proceedings include a range of topics, such as mindfulness training, application of virtual technologies, preparing for the National Board of Medical Examiners subject exam, palliative care, and how students judge their communication skills in Objective Structured Clinical Examinations. These abstracts, representative of ADMSEP educational research, were chosen for their general interest to medical student educators.     

Emergency Medicine Gender‐specific Education

The 2014 Academic Emergency Medicine consensus conference has taken the first step in identifying gender‐specific care as an area of importance to both emergency medicine (EM) and research. To improve patient care, we need to address educational gaps in this area concurrent with research gaps. In this article, the authors highlight the need for sex‐ and gender‐specific education in EM and propose guidelines for medical student, resident, and faculty education. Specific examples of incorporating this content into grand rounds, simulation, bedside teaching, and journal club sessions are reviewed. Future challenges and strategies to fill the gaps in the current education model are also described.     

Clerkship Directors in Emergency Medicine: Statement of Purpose

The Academy of Clerkship Directors in Emergency Medicine (CDEM) provides a forum for the collaborative exchange of ideas among emergency medicine (EM) medical student educators, a platform for the advancement of education, research, and faculty development, and establishes for the first time a national voice for undergraduate medical education within our specialty. CDEM plans to take a leading role in providing medical student educators with additional educational resources and opportunities for faculty development and networking. CDEM will work to foster the professional growth and development of undergraduate medical educators within our specialty. The advancement of undergraduate education within our specialty and beyond will come primarily from the support, hard work, and dedication of the educators. To accomplish our goals, at the departmental, medical school, and national level, we must come together to further promote our specialty across the spectrum of undergraduate medical education. The first step has already been taken with the formation of the Academy of CDEM.     

The Effect of Emergency Department Crowding on Education: Blessing or Curse?

Emergency department (ED) crowding is a national crisis that contributes to medical error and system inefficiencies. There is a natural concern that crowding may also adversely affect undergraduate and graduate emergency medicine (EM) education. ED crowding stems from a myriad of factors, and individually these factors can present both challenges and opportunities for education. Review of the medical literature demonstrates a small body of evidence that education can flourish in difficult clinical environments where faculty have a high clinical load and to date does not support a direct deleterious effect of crowding on education. To provide a theoretical framework for discussing the impact of crowding on education, the authors present a conceptual model of the effect of ED crowding on education and review possible positive and negative effects on each of the six recognized Accreditation Council for Graduate Medical Education (ACGME) core competencies.     

Effect of Changes in Graduate Medical Education Funding on Emergency Medicine Residency Programs

OBJECTIVE: To determine whether changes in graduate medical education (GME) funding have had an impact on emergency medicine (EM) residency training programs. METHODS: A 34-question survey was mailed to the program directors (PDs) of all 115 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs in the United States in the fall of 1998, requesting information concerning the impact of changes in GME funding on various aspects of the EM training. The results were then compared with a similar unpublished survey conducted in the fall of 1996. RESULTS: One hundred one completed surveys were returned (88% response rate). Seventy-one (70%) of the responding EM residency programs were PGY-I through PGY-III, compared with 55 (61%) of the responding programs in 1996. The number of PGY-II through PGY-IV programs decreased from 25 (28%) of responding programs in 1996 to 17 (16%). The number of PGY-I through PGY-IV programs increased slightly (13 vs 10); the number of EM residency positions remained relatively stable. Fifteen programs projected an increase in their number of training positions in the next two years, while only three predicted a decrease. Of the respondents, 56 programs reported reductions in non-EM residency positions and 35 programs reported elimination of fellowship positions at their institutions. Only four of these were EM fellowships. Forty-six respondents reported a reduction in the number of non-EM residents rotating through their EDs, and of these, 11 programs reported this had a moderate to significant effect on their ability to adequately staff the ED with resident physicians. Sixteen programs limited resident recruitment to only those eligible for the full three years of GME funding. Eighty-seven EM programs reported no change in faculty size due to funding issues. Sixty-two programs reported no change in the total number of hours of faculty coverage in the ED, while 34 programs reported an increase. Three EM programs reported recommendations being made to close their residency programs in the near future. CONCLUSIONS: Changes in GME funding have not caused a decrease in the number of existing EM residency and fellowship training positions, but may have had an impact in other areas, including: an increase in the number of EM programs structured in a PGY-I through PGY-III format (with a corresponding decrease in the number of PGY-II through PGY-IV programs); a decrease in the number of non-EM residents rotating through the ED; restriction of resident applicants who are ineligible for full GME funding from consideration by some EM training programs; and an increase in the total number of faculty clinical hours without an increase in faculty size.     

The Business of Emergency Medicine: A Nonclinical Curriculum Proposal for Emergency Medicine Residency Programs

Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty.