• Shyam Murali

Structuring a medical student rotation in an EM Residency - Senior Scholarly Project Spotlight

Throughout the year, we plan to feature unique projects that our senior residents have worked on. Some explore the scientific aspects of EM while others aim to improve the quality of our emergency department. Regardless, they have lasting impacts on our residency and the way we practice medicine.

This Senior Scholarly Project Spotlight is brought to you by Dr. Tyler Gombash (last year's Academic Chief) and is a QI project to improve the medical student rotation in our department.


Objective

  • Evaluate which method of structuring a medical student rotation with an emergency medicine residency will result in: - Greater student satisfaction - Greater resident satisfaction - Higher patient numbers for students


Setting

  • Emergency Department of Mercy St. Vincent Medical Center has over 100 student rotators per year. The department is staffed with an emergency medicine residency of 42 residents. The emergency department itself has 50 beds and a 70,000 annual patient census


Participants

  • Inclusion: All students and residents rotating in the emergency Department will be involved.

  • Exclusion: None


Overview

Students will experience either:

  • “Independent Practitioner” model - Scheduled to come in at a certain time and see whichever patients they want and present to whichever resident was seeing that patient - Old rotation method - Control group

  • “Resident Extender” model - Scheduled with a single individual resident and see most of the patients that resident sees during the shift - New rotation method - Experimental group


Analysis

  • Second and third year residents were given a questionnaire (10-point Likert Scale) at the beginning of the academic year and asked 12 questions about their experience with medical students, prior to the switch to the Resident Extender model implementation

  • Same questions were asked 8 months later after new Resident Extender schedule set up

  • Medical students from the prior academic year were asked 13 questions about rotation under the Independent Practitioner model

  • Same 13 questions were asked during the following academic year as medical students completed rotation under the Resident Extender schedule


Results

Resident Survey - all questions had improved responses; 5 responses (bolded) had improvements greater than 1 point.

  • Q1: I was able to see patients efficiently while working with the medical students Independent Practitioner Model 5.21, Resident Extender Model 5.94

  • Q2: Working with medical students enhanced my clinical practice Independent Practitioner Model 4.88, Resident Extender Model 6.00

  • Q3: Working with medical students made me a better clinician Independent Practitioner Model 4.92, Resident Extender Model 5.69

  • Q4: I learned more on my shifts because the medical students were present Independent Practitioner Model 4.33, Resident Extender Model 5.18

  • Q5: I enjoyed my shifts because I was working with students Independent Practitioner Model 5.33, Resident Extender Model 5.50

  • Q6: I was able to accomplish more with the medical students that I would have working alone Independent Practitioner Model 3.54, Resident Extender Model 4.12

  • Q7: I had adequate exposure to the medical student to give a good evaluation Independent Practitioner Model 5.13, Resident Extender Model 8.00

  • Q8: I was able to appropriately supervise the medical students Independent Practitioner Model 6.41, Resident Extender Model 8.12

  • Q9: I was able to give specific feedback to the medical students Independent Practitioner Model 7.29, Resident Extender Model 8.24

  • Q10: I was able to expose medical students to wide variety of patient presentation Independent Practitioner Model 6.33, Resident Extender Model 8.06

  • Q11: I was able to incorporate the medical student into the care of critically ill patients Independent Practitioner Model 4.21, Resident Extender Model 6.53

  • Q12: I was able to supervise the medical students performing procedure Independent Practitioner Model 6.67, Resident Extender Model 6.41


Medical Student Survey - improved responses are bolded, worsened responses are underlined

  • Q1: During this rotation I became better at doing a focused history Independent Practitioner Model 8.76, Resident Extender Model 8.60

  • Q2: During this rotation I became better at doing a focused physical exam Independent Practitioner Model 8.6, Resident Extender Model 7.90

  • Q3: I received direct input on my performance in taking a history and performing a physical exam Independent Practitioner Model 6.92, Resident Extender Model 8.00***

  • Q4: I became better at formulating a differential diagnosis Independent Practitioner Model 8.28, Resident Extender Model 8.40

  • Q5: I had an opportunity to make decisions regarding the workup of patients Independent Practitioner Model 7.76, Resident Extender Model 8.53

  • Q6: I had an opportunity to make decisions regarding disposition of patients Independent Practitioner Model 6.8, Resident Extender Model 7.10

  • Q7: I was more comfortable working in the emergency department environment Independent Practitioner Model 9.12, Resident Extender Model 8.73

  • Q8: I received specific feedback that helped me develop as a clinician Independent Practitioner Model 7.92, Resident Extender Model 8.00

  • Q9: I saw a wide variety of patient presentations Independent Practitioner Model 8.96, Resident Extender Model 8.97

  • Q10: I had an opportunity to participate in the care of critically ill patients Independent Practitioner Model 8.16, Resident Extender Model 7.73

  • Q11: I participated (observed, performed, or assisted) in an appropriate number of procedures. Independent Practitioner Model 8.52, Resident Extender Model 7.83

  • Q12: I feel that I was appropriately supervised Independent Practitioner Model 8.84, Resident Extender Model 9.23

  • Q13: I feel I had enough contact with instructors to get a fair evaluation for my grade Independent Practitioner Model 7.28, Resident Extender Model 7.97


***Improved by greater than 1 point


Discussion

  • Residents seemed to like the new system more

  • Surprised we did not see more change in student averages in favor of the new system - Old system questionnaire filled out by more late third years, perhaps not as interested in EM? New system questionnaire filled out by more auditioning fourth years who had done more EM rotations?

  • Of note, there was a comments section at end of students questionnaire - Independent Practitioner Model had 4 responses saying how it was difficult to work with many residents and finding who to present the patient to. Intimidating to introduce yourself to many new resident. - New system had more general positive response (in particular for Justin Cole and Rachel Zinsou) - Most commented improvement for rotation: > Residents provide more/better feedback > Allowed students to present to attendings more > Keep students involved in plans and disposition

Conclusion

Based on data collected from this study, we should keep the new way to schedule medical students rather than reverting back to the old way.

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