Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Objective: This Institutional Review Board-approved, prospective, observational study compared the clinical performance of senior medical students in an emergency medicine (EM) clerkship using a clinical behavioral evaluation tool in which one group had mandatory, topic specific readings and the other did not.

Methods: The study took place in an urban, tertiary referral center emergency department treating 43,000 patients annually and supporting medical student clerkships and an EM residency. The grades of two groups of senior medical students participating in an elective EM clerkship were compared. Those students during the 2002-2004 academic years were not assigned mandatory, topic-specific reading for the clerkship, while those during the 2004-2007 academic years were. The groups were compared on baseline demographic information, prior academic performance, and EM clerkship grade distributions using appropriate statistical techniques, including multinomial logistic regression, chi-square tests, and Fisher’s Exact tests.

Results: The control and experimental groups each had 83 subjects and were similar in baseline characteristics, except for the control group performing better than the experimental group during the basic science training of medical school (years 1-2; p=0.01). The experimental group had statistically significant more members in the EM Interest Group (EMIG; p=0.0001) and more members who went on to match in an EM residency (p=0.0007). The difference in grade distributions between the control group and experimental group was not statistically significant (p=0.40). Of note, those student members of the EMIG (p=0.0005) and those later matching to an emergency medicine residency (p<0.0001) were more likely to earn a grade of “honors” for the clerkship.

Conclusion: The addition of uniform, topic-specific reading assignments to an EM senior medical student curriculum does not improve the overall clinical performance of those students as measured using a clinical behavioral evaluation tool.

[WestJEM. 2009;10:23-29.]