Emergency Medicine Subinternship: Can We Provide a Standard Clinical Experience?


Department of Emergency Medicine, Box 21, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA 90509-2910. Fax: 310-212-6100; e-mail: coates@emedharbor.edu.


Medical students have varied experiences on the emergency medicine (EM) subinternship. Didactic curricula can be standardized. Objectives: To determine if uniformity in clinical curricula is possible by assessing whether students can see patients with certain chief complaints (CC). Methods: Prospective interventional analysis at a public teaching hospital. Control group (CG) students saw patients of their choice and recorded encounters in logbooks. Test group (TG) students were asked to see at least one patient with: orthopedic injury (OR); asthma exacerbation (AE); acute coronary syndrome (ACS); traumatic injury (TR); laceration (LAC); or diabetic ketoacidosis (DKA). TG students prospectively recorded these patients on a separate logbook page. Logbooks were reviewed by two investigators to determine if a patient with each diagnosis was seen. Chi-square analysis tested for differences in sample proportions between TG and CG. Multivariate analyses controlled for TG, specialty choice, and gender. p < 0.05 represented statistical significance. Results: One hundred fifty (88 TG; 62 CG) students participated. Differences existed between TG and CG in the proportion of students who saw a patient with each CC: OR: 93% TG, 69% CG (p < 0.0001); AE: 86% TG, 63% CG (p < 0.0008); ACS: 97% TG, 58% CG (p < 0.0001); TR: 97% TG, 58% CG (p < 0.0001); LAC: 98% TG, 89% CG (p < 0.0220); DKA: 68% TG, 47% CG (p < 0.0086). Logistic regressions explaining the probability of seeing each CC showed the variable controlling for TG was positive and significant for 5 CCs: p = 0.0013 (OR); 0.0038 (AE); 0.0001 (ACS); 0.0001 (TR); 0.0229 (DKA). No difference was found for LAC: p = 0.0570. Conclusions: Students can be directed to see patients with particular CCs. TG students saw more patients with certain CCs than CG students, p < 0.0001. This intervention can help educators provide a well-rounded, uniform clinical EM experience.