The emergency medicine subinternship - A standard experience for medical students?

Objective: To determine whether emergency medicine (EM)-bound and non-EM-bound senior medical students on the EM subinternship have a uniform experience with respect to number and acuity of patients seen and procedures performed. Methods: Prospective observational analysis of patient diagnosis and procedures recorded in logs by students at a public teaching hospital over 12 consecutive months. Logs were reviewed blindly and assigned an acuity level based on predetermined criteria. Preselected procedures were categorized as general or surgical and tallied. Identity, specialty choice, gender, and month of rotation for each student were identified. Results: Seventy of 74 students completed logs. On average, 34 EM-bound students saw 59.82 patients (95% CI = 55.19 to 64.45) and performed 10.58 procedures (95% CI = 8.62 to 12.56); 36 non-EM-bound students saw 51.17 patients (95% CI = 47.41 to 54.90) and performed 8.33 procedures (95% CS = 6.81 to 9.84). Univariate analysis showed EM-bound students saw more patients than non-EM- bound students, performed more surgical procedures, and saw higher-acuity patients (p = 0.004; 0.009; 0.016). Multivariate analyses controlled for EM specialty, gender, and month. Significant effects for EM specialty were found (ordinary least squares) for number of patients, procedures, and surgical procedures (p = 0.013; 0.048; 0.011). Logistic regression explaining acuity level showed EM specialty and gender were significant (p = 0.010; 0.038). Conclusions: In an EM subinternship, experience was variable between EM-bound and non-EM-bound students. Male students saw lower-acuity patients. The EM-bound students saw more patients, higher-acuity patients, and performed more procedures than non-EM-bound cohorts. Emergency medicine educators responsible for medical education should be aware of these differences.