ACADEMIC EMERGENCY MEDICINE • March 2001, Volume 8, Number 3
253
The Emergency Medicine Subinternship—A Standard
Experience for Medical Students?
WENDY C. COATES, MD, ANDREW M. GILL, PHD
Abstract. Objective: To determine whether emer- bound students, performed more surgical procedures,
gency medicine (EM)-bound and non-EM-bound sen- and saw higher-acuity patients (p = 0.004; 0.009;
ior medical students on the EM subinternship have 0.016). Multivariate analyses controlled for EM spe-
a uniform experience with respect to number and cialty, gender, and month. Significant effects for EM
acuity of patients seen and procedures performed. specialty were found (ordinary least squares) for
Methods: Prospective observational analysis of pa- number of patients, procedures, and surgical proce-
tient diagnosis and procedures recorded in logs by dures (p = 0.013; 0.048; 0.011). Logistic regression ex-
students at a public teaching hospital over 12 consec- plaining acuity level showed EM specialty and gender
utive months. Logs were reviewed blindly and as- were significant (p = 0.010; 0.038). Conclusions: In
signed an acuity level based on predetermined crite- an EM subinternship, experience was variable be-
ria. Preselected procedures were categorized as tween EM-bound and non-EM-bound students. Male
general or surgical and tallied. Identity, specialty students saw lower-acuity patients. The EM-bound
choice, gender, and month of rotation for each student students saw more patients, higher-acuity patients,
were identified. Results: Seventy of 74 students com- and performed more procedures than non-EM-bound
pleted logs. On average, 34 EM-bound students saw cohorts. Emergency medicine educators responsible
59.82 patients (95% CI = 55.19 to 64.45) and per- for medical education should be aware of these dif-
formed 10.58 procedures (95% CI = 8.62 to 12.56); 36 ferences. Key words: Emergency medicine; medical
non-EM-bound students saw 51.17 patients (95% CI student; clerkship; undergraduate medical education;
= 47.41 to 54.90) and performed 8.33 procedures (95% education; career choice. ACADEMIC EMERGENCY
CI = 6.81 to 9.84). Univariate analysis showed EM- MEDICINE 2001; 8:253–258
bound students saw more patients than non-EM-
HE ability of all graduating medical students tient encounters. A significant responsibility for
to manage acutely ill patients is recognized learning in the clinical setting depends exclusively
T
as a critical element of undergraduate medical ed-
ucation.1 The implementation of a curriculum in
emergency medicine (EM) that spans all four years
of medical school is desirable.2 Guidelines for such
a curriculum are easily available, yet many schools
on the motivation of each student. It is plausible
that student initiative may produce a widely var-
iable experience within the confines of the same
educational opportunity. There is anecdotal evi-
dence that students who are bound for a career in
EM see more patients, see sicker patients, and are
likely to perform more procedures, on average,
than other medical students at the same level of
training.
As one of their responsibilities for the subin-
ternship at our institution, medical students keep
a log of patients seen and their diagnoses, and any
procedures performed. This logbook serves as a
useful tool to ensure the students’ presence on each
shift and to evaluate the types of patient encoun-
ters throughout the rotation. The beneficial edu-
cational effect of logbooks is well documented for
clinical rotations.7–9 During the clerkship orienta-
tion, students are told that some of the entries into
the logbook may be validated by the clerkship di-
rector by comparing the logbook with the patient’s
emergency department (ED) chart. Misrepresen-
tation of experience in the logbook can result in a
final grade of ‘‘fail’’ in the subinternship. The num-
ber and assigned acuity category of patients seen
do not offer EM courses before the senior year.3,4
A
quality standardized experience for the senior sub-
internship in EM is crucial to ensure proficiency in
acute care and consistency in both didactic and
clinical training. Some centers have instituted pro-
grams to provide uniformity in core knowledge.5,6
Uniformity in didactic knowledge seems much eas-
ier to achieve than experiences that depend on pa-
From the Harbor–UCLA Medical Center, Department of Emer-
gency Medicine,Torrance, CA (WCC); and California State Uni-
versity, Fullerton, Department of Economics, Fullerton, CA
(AMG).
Received May 25, 2000; revision received November 1, 2000;
accepted November 6, 2000.
Presented at the SAEM annual meeting, San Francisco, CA,
May 2000.
Address for correspondence and reprints: Wendy C. Coates,
MD, Department of Emergency Medicine, Box 21, Harbor–
UCLA Medical Center, 1000 West Carson Street, Torrance,
CA 90509-2910. Fax: 310-212-6101; e-mail: coates@
emedharbor.edu