Attaining academic department status for emergency medicine within medical schools

1st- and 2nd-year medical student exposure to emergency medicine

BACKGROUND

Medical societies in emergency medicine (EM) have recommended teaching EM topics in the preclinical years of medical school. However, the magnitude of integrating an EM curriculum into the 1st and 2nd year of medical school is unknown.

PURPOSE

The purpose of this survey was to determine the extent and type of exposure to EM in the 1st and 2nd years of medical schools in the United States.

METHODS

The deans of all allopathic and osteopathic medical schools in the country were surveyed by mail. The survey took the form of a questionnaire and had seven questions that included type of exposure, number of students, length of the exposure, learning objectives, lectures, laboratory, textbook, evaluation process and grades, departmental status, board certification, emergency department volume, and size of the medical school class. The data were analyzed with SPSS software.

RESULTS

The survey was returned by 84 of the 125 (67.2%) medical schools in the country. The average class size was 129.0 students. As many as 63.9% of the medical schools responding provided EM exposure in the 1st year and 54.3% in the 2nd year. The 1st-year exposure most frequently used more than one type of teaching activity (47.4%), observation (12.3%), cardiopulmonary resuscitation training (15.8%), universal precautions (7.0%), and other (17.5%). None taught physical diagnosis. The various teaching activities lasted anywhere from hours (27.5%), to days (25.3%) or weeks (52.5%), with a mean of 2.25 weeks. Second-year exposure most frequently included multiple activities (49.0%), observation (16.3%), or other activities (14.3%); a few taught physical diagnosis (8.2%), cardiopulmonary resuscitation training (6.1%), or universal precautions (6.1%). These teaching activities lasted from hours (20.6%), to days (14.7%) or weeks (64.7%), with a mean of 2.44 weeks.

CONCLUSIONS

Most U.S. medical schools provide EM exposure in the first 2 years of medical school, lasting slightly more than 2 weeks in length most frequently covering multiple topics.

Role of emergency medicine residency programs in determining emergency medicine career choice among medical students

STUDY OBJECTIVE

To characterize the role of emergency medicine residency programs in determining emergency medicine career choice among medical students.

DESIGN

Observational, cross-sectional, descriptive study. Information on student career choice was obtained through a targeted query of the National Resident Matching Program data base, simultaneously stratified by specialty and school, and adjusted for class size.

PARTICIPANTS

All accredited emergency medicine residency programs and four-year allopathic medical schools.

RESULTS

Fifty-two schools (42%) had a closely affiliated emergency medicine residency program, ie, one based primarily at the institution's main teaching hospital(s). This configuration was associated with a 70% increase in the median proportion of students choosing emergency medicine as a career when compared to the 73 schools with no closely affiliated emergency medicine residency (5.1% vs 3.0%, P < .0001). When institutions were stratified by overall commitment to emergency medicine, the median proportion of students choosing emergency medicine as a career was 2.9% for institutions with a minimal commitment to emergency medicine (neither an academic department of emergency medicine nor a closely affiliated emergency medicine residency), 4.1% for institutions with a moderate commitment to emergency medicine (either a department of emergency medicine or an emergency medicine residency, but not both), and 5.7% for institutions with a substantial commitment to emergency medicine (a department of emergency medicine and an emergency medicine residency) (P < .0001). When institutional commitment to emergency medicine was examined in a simple multivariate model, only the presence of an emergency medicine residency was associated independently with student career choice (P < .001).

CONCLUSION

An emergency medicine residency program that is closely affiliated with a medical school is strongly and independently associated with a quantitatively and statistically significant increase in the proportion of students from that school who choose a career in emergency medicine. These data support the proposition that, if emergency medicine is to meet national manpower shortage needs by attracting students to the specialty, it must establish residency programs within the primary teaching hospital(s) of medical schools. Such a configuration does not currently exist in the majority of schools.

An evaluation of a logbook for trainees in accident & emergency medicine in the United Kingdom: senior consultant opinion

A previous paper from the Merseyside Group of Senior Registrars in Accident & Emergency Medicine examined the desirability of a logbook for Higher Specialist Training (HST) in accident & emergency medicine in the United Kingdom and its principal ingredients (Luke et al., 1991). A survey of 100 senior registrars and recently appointed consultants in the specialty identified the main issues of importance to the majority of respondents e.g. certification in advanced cardiac and trauma life support, a minimum of three years in the specialty before appointment as senior registrar and certain key secondments. In this paper, more senior consultants in the specialty were surveyed and a resounding majority concurred with the preferences of their junior colleagues. The findings are discussed and the implications for a future curriculum for postgraduate training in A&E medicine are explored.