Optimising medical student experiences in Emergency Medicine

Background/Introduc.on  

EM   placements   are   popular   with   UK   medical   students,   and   Elec7ves/Student   Selected   Components   allow   longer   placements   than   the  standard  curriculum.    

We  wished  to  explore  the  rela7onship  between  student  sa7sfac7on  with  these   longer   ED   placements,   type   of   hospital,   stage   of   training   and  availability  of  opportuni7es  and  supervision.    

Method  

Using   social   media,   we   appealed   for   medical   students   who   had  undertaken  an  EM  placement  of  at  least  four  weeks  in  dura7on  in  the  last  five  years  to  complete  an  online  ques7onnaire  (n=35).    

Using  a  scale  of  1  (strongly  disagree)  to  10  (strongly  agree)  respondents  rated   their   agreement   with   a   series   of   statements   about   learning  opportuni7es  in  ED  &  competencies  acquired.    

Results    

Overall,  29/35  (83%)  said  their  EM  placement  was  “a  highlight  of  medical   school”.   These   students  were  more   likely   to   have   seen  pa7ents  afresh,  and  had  significantly  easier  access  to  supervision  (t  (33)  =  2.17,  p  <  0.05).    

Both   these   factors  were  more  commonly   reported  by   students  whose  EM  placement  was  in  a  District  General  Hospital  (DGH)  cf.  city  teaching  hospital.  

Among  students  who  undertook  their  EM  placement  in  the  final  two   years   of   medical   school,   94%   said   it   was   a   highlight,  significantly  more  than  the  64%  whose  placement  was  earlier  in  their  medical  school  career.    

More   senior   students   reported   fewer   problems   accessing   ED  doctors  with  capacity  to  handle  pa7ents  they  had  clerked.  

Conclusion  

Student  sa7sfac7on  with  an  Emergency  Medicine  placement  is  a  complex  combina7on  of  departmental    culture,   learning  opportuni7es,  quality  of  supervision  and  case-­‐mix.    

Our   findings   confirm   that   access   to   supervision   is   integral   to   student  sa7sfac7on   &   hints   that   more   junior   students   encounter   difficul7es   in  finding   doctors   free   to   present   cases   to.   Teaching   hospital   placements  score  poorly  regarding  student  sa7sfac7on  compared  with  DGHs,  but  this  may  be  skewed  by  junior  students  being  significantly  more  likely  to  have  undertaken  a  teaching  hospital  placement  rather  than  DGH.    

We  suspect  the  tradi7onal  ED  “see  &  present”  placement  is  less  suitable  for   junior  medical   students  &   less   rewarding   for  ED  doctors   supervising  them,   influencing   the   lower   sa7sfac7on   expressed   by   junior   students.  Alterna7ve  models   for  hos7ng   junior  medical   student  placements   in  ED  should   be   considered:   recruitment   difficul7es   to   the   specialty   will   be  compounded  if  those  who  ac7vely  seek  EM  placements  as  junior  medical  students   do  not   enjoy   them,   and   it   it   known   that  many   students  make  commiZed  career  decisions  early  in  medical  school  (Ref  1).  

Reference  1.  Zeldow,  P.  B.,  Preston,  R.  C.,  &  Daugherty,  S.  R.  (1992).    The  decision  to  enter  a  medical  specialty:  timing  and  stability.  Medical  Education,  26,  327-­‐332.

Photo:    Aneurin  Bevan  Health  Board