Medical Education, Medical Students

The Case for a Universal Emergency Medicine Clerkship

Next time you pass the red "EMERGENCY" sign that sits above the ambulance bay, try to think of a specialty that doesn't interact with the emergency department.

Emergency medicine (EM) is often absent from undergraduate medical training. In a recent poll, researchers found that only 52% of U.S. medical schools require an EM rotation.1 The lessons learned through an EM clerkship are unique, practical, and necessary. It is time to make EM the newest core third-year clerkship.

Since the first EM residency program was established in Cincinnati in 1970, more than 250 allopathic/osteopathic residency programs have been founded around the United States. As of 2014, there were 45,140 emergency medicine physicians practicing in the U.S.2 In 2016 and 2017, 33 and 21 new programs, respectively, were accredited by the ACGME.3 The popularity of the field, and the need for newly minted emergency physicians, is well-established.

There are many compelling arguments for making EM a mandatory third-year clerkship. EM rotations forge better, more confident medical students. Additionally, patients generally enjoy having students in the clinical setting. Finally, almost every specialty will interact with the emergency department at some point - as the front line and safety net of care, emergency medicine is central to the health care system in America.

Student Experience
EM rotations make medical students better, more confident students. A 2002 study from the Journal of Emergency Medicine details how early exposure to emergency medicine and the "undifferentiated patient" can help medical students in their preparation for any specialty.6 Emergency medicine offers a one-of-a-kind setting where students are exposed to every medical specialty, from radiology to psychiatry, and everything in between.

Patient Experience
Patients enjoy having medical students in the ED setting. Students have been shown to increase patient satisfaction and have never been found to decrease patient satisfaction scores.7-9

Career Experience
Emergency medicine is a unique, increasingly popular, and important educational field. It is time for a paradigm shift here. The fact that almost half of U.S. medical students are not required to complete an EM clerkship prior to graduation is, at best, precarious.

Next time you pass the red "EMERGENCY" sign that sits above the ambulance bay, try to think of a specialty that doesn't interact with the emergency department. You will be hard-pressed to come up with a good answer. At some point in a physician's career, they will be exposed to emergency medicine. It is time our medical students are as well.


References

  1. Wald DA, Manthey DE et al. The State of the Clerkship: A Survey of Emergency Medicine Clerkship Directors. Acad Emerg Med. 2007;14(7):629-634. doi:10.1197/j.aem.2007.02.035.
  2. Reiter M, Wen LS et al. The Emergency Medicine Workforce: Profile and Projections. The Journal of Emergency Medicine. 2016;50(4):690-693. doi:10.1016/j.jemermed.2015.09.022.
  3. List of Newly Accredited Emergency Medicine Programs. https://apps.acgme.org/ads/Public/Reports/Report/8.
  4. Gallagher EJ, Goldfrank LR et al. Role of emergency medicine residency programs in determining emergency medicine career choice among medical students. Annals of Emergency Medicine. 1994;23(5):1062-1067. doi:10.1016/s0196-0644(94)70104-0.
  5. Nagurka R, Scott S et al. Impact of an emergency medicine clerkship on students' perceptions of emergency medicine. Advances in Medical Education and Practice. 2015:105. doi:10.2147/amep.s77037.
  6. Pitre CJ. The unique educational value of emergency medicine student interest groups. The Journal of Emergency Medicine. 2002;22(4):427-428. doi:10.1016/s0736-4679(02)00442-0.
  7. Esguerra R, Toro J et. al. The transition to a teaching hospital: Patient satisfaction before and after the introduction of medical students. Medical Teacher. 2014;36(8):710-714. doi:10.3109/0142159x.2014.907877.
  8. Nagurka R, Scott S et al. Impact of an emergency medicine clerkship on students' perceptions of emergency medicine. Advances in Medical Education and Practice. 2015:105. doi:10.2147/amep.s77037.
  9. Bernard A, Martin D et al. The Impact of Medical Student Participation in Emergency Medicine Patient Care on Departmental Press Ganey Scores. Western Journal of Emergency Medicine. 2015;16(6):830-838. doi:10.5811/westjem.2015.9.27321.

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