Clinical Assessment of Medical Students in the Emergency Department, a National Consensus Conference

Assessing Individual Competency Differences Between Third- and Fourth-Year Medical Students Using the National Clinical Assessment Tool for Medical Students in the Emergency Department

Medical students rotating through emergency departments as part of their clinical education are typically evaluated using an on-shift evaluation tool. The National Clinical Assessment Tool for Medical Students in the Emergency Department (NCAT-EM) is the current standard of evaluation for medical students in the emergency department, regardless of level of training. This study aims to evaluate whether the NCAT-EM can detect differences in skill levels between third-year medical students (MS3s) and fourth-year medical students (MS4s) rotating at a level 1 trauma center and teaching institution. These authors hypothesized that MS4s should outperform MS3s across all assessment domains given their additional training. A total of 930 performance evaluations were gathered for MS3 and MS4 rotating between May 2022 and June 2023. There were 321 evaluations of MS3s and 609 evaluations of MS4s. Across the six assessment domains, MS4s had statistically significant higher performances in two domains - namely emergency recognition and management (fully entrustable: 37.4% vs. 23.8% (p = 0.03)) and communication (fully entrustable: 46.2% vs. 33.6% (p = 0.03)). These findings indicate that the use of the NCAT-EM at this institution reliably differentiated between MS3s and MS4s in these two assessment domains. There were trends suggesting MS4s outperform MS3s in the other four domains, which did not rise to the level of statistical significance, but are consistent with prior validation studies of the NCAT.

Assessment of Professionalism During the Emergency Medicine Clerkship Using the National Clinical Assessment Tool for Medical Students in Emergency Medicine

OBJECTIVES

In 2016, a national consensus conference created the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM), a standardized end-of-shift assessment tool. We report the first large-scale analysis of professionalism concerns collected from May 2017 through December 2018 by a multisite consortium using the NCAT-EM. Our primary objective was to characterize the nature and frequency of professionalism concerns. Our secondary objective was to identify characteristics associated with giving or receiving a professionalism flag.

METHODS

The consortium database includes assessments for all students on EM clerkships at participating sites. This report presents descriptive statistics about the frequency of different flags, the distribution of flags among different student categories, assessor and student characteristics, and distribution of global assessment scores on assessments citing concerns. We used Fisher's exact test to look for associations between the frequency of professionalism flags and the sex of the students and assessors and across student categories. We used logistic regression to look for relationships between professionalism concerns and global assessment scores as well as intent to apply in EM.

RESULTS

We screened 6,768 assessments of 784 students by 719 assessors from 13 sites. After excluding assessments without flags and assessments with apparent data entry errors, we analyzed 57 (0.8%) assessments containing 79 flags. The most frequent flags were punctuality (25/79, 31.6%) and initiative (20/79, 25.3%). Few students received flags (42/784, 5.4%). Few assessors flagged concerns (41/719, 5.7%). We detected no correlation between the frequency of flags and whether a student was applying in EM or between the sex of students and assessors. Global scores of lower one-third appeared more often in assessments with a flag (30/57, 52.6% vs. 233/6,711, 3.5%).

CONCLUSIONS

Only 5.4% of students received flags. Punctuality and initiative accounted for a majority of citations. Professionalism flags correlated strongly with lower global assessment scores.

Multi-institutional Implementation of the National Clinical Assessment Tool in Emergency Medicine: Data From the First Year of Use

OBJECTIVES

Uniformly training physicians to provide safe, high-quality care requires reliable assessment tools to ensure learner competency. The consensus-derived National Clinical Assessment Tool in Emergency Medicine (NCAT-EM) has been adopted by clerkships across the country. Analysis of large-scale deidentified data from a consortium of users is reported.

METHODS

Thirteen sites entered data into a Web-based platform resulting in over 6,400 discrete NCAT-EM assessments from 748 students and 704 assessors. Reliability, internal consistency analysis, and factorial analysis of variance for hypothesis generation were performed.

RESULTS

All categories on the NCAT-EM rating scales and professionalism subdomains were used. Clinical rating scale and global assessment scores were positively skewed, similar to other assessments commonly used in emergency medicine (EM). Professionalism lapses were noted in <1% of assessments. Cronbach's alpha was >0.8 for each site; however, interinstitutional variability was significant. M4 students scored higher than M3 students, and EM-bound students scored higher than non-EM-bound students. There were site-specific differences based on number of prior EM rotations, but no overall association. There were differences in scores based on assessor faculty rank and resident training year, but not by years in practice. There were site-specific differences based on student sex, but overall no difference.

CONCLUSIONS

To our knowledge, this is the first large-scale multi-institutional implementation of a single clinical assessment tool. This study demonstrates the feasibility of a unified approach to clinical assessment across multiple diverse sites. Challenges remain in determining appropriate score distributions and improving consistency in scoring between sites.