Impact of EMS education on emergency medicine ability and career choices of medical students

Developing Medical Student Competencies, Clinical Skills, and Self-Efficacy With an Emergency Medical Responder Certification Course

Introduction

Previous studies have claimed gap year clinical experiences before medical school matriculation increase student self-efficacy and clinical confidence. At the University of Central Florida College of Medicine, 41 first-year medical students participated in a new certification course to become emergency medical responders before beginning their coursework. This study describes the results of a follow-up study that aims to investigate the impact the course had on student competency, self-efficacy, and clinical efficacy and if the course would prepare students similarly to previous clinical experience.

Methods

First-year medical students completed a 30-question survey consisting of a Likert scale and free-response questions. Questions were based on the Accreditation Council for Graduate Medical Education core competencies: medical knowledge, practice-based learning and improvement, systems-based practice, patient care, professionalism, and interpersonal and communication skills. Questions on the perceived benefit of the emergency medical responder course and previous clinical experiences were also included. Responses were separated based on participation in the emergency medical responder course and prior clinical experience. Two-tail Welch’s t-tests were performed on the data to determine significance.

Results

Of 98 responses: 20.4% (20/98) of participants of the emergency medical responder course had previous clinical experience, 21.5% (21/98) of participants of the course had no clinical experience, 26.5% (26/98) did not participate in the course but had previous clinical experience, and 31.6% (31/98) did not participate in the course nor had previous clinical experience. Students with previous clinical experience reported the emergency medical responder course improved both their patient care skills and performance in courses that emphasized patient interviewing and physical exams. Students with clinical experience had significantly higher medical knowledge (p < 0.1) and professionalism (p < 0.1) Likert scores. Eighty-seven percent of students agreed the course had a positive impact on their patient care skills.

Conclusion

Larger sample size is needed to make stronger conclusions; however, the responses show the emergency medical responder course had a positive subjective impact on students with previous medical experience. Previous clinical experience leads to the most positive subjective reporting of competencies such as medical knowledge and professionalism. Early clinical exposure, such as an emergency medical responder certification course, may improve self-efficacy and patient care skills for medical students with no previous clinical experience.

Medical Students' Perceptions of Emergency Medicine Careers

Introduction

Previous studies on specialty choice have investigated specialty characteristics that are appealing to undergraduate students. Little is known about how students’ attitudes towards Emergency Medicine (EM) careers evolve over their schooling.

Methods

An open-ended survey of medical students’ career interests was distributed five times over the four-year undergraduate curriculum from 1999 to 2008 at Memorial University. We tested specialty choices across genders, and looked at how likely a student’s choice in their first year influenced their final year choice, a metric we termed “endurance”. The qualitative data was coded to identify key themes and sentinel quotes. Lastly, we conducted semi-structured interviews with academic emergency physicians at Dalhousie University to assess the relevance of these findings to postgraduate training.

Results

Males expressed more interest in EM than females. EM had more endurance than internal medicine, but less than family medicine, over the four-year curriculum. The biggest drawbacks for EM included lack of patient follow-up and lack of EM experience; positive perspectives focused on clinical variety and elective experiences. Lifestyle was prominent, seen as both positive and negative. Emergency physicians considered EM lifestyle attractive, and characterized medical students’ perceptions as “skewed,” highlighting lack of insight into system flaws.

Conclusions

Medical students’ opinions towards EM tended to shift over time, particularly the perception of the work. Medical students’ perceptions differ from that of experienced emergency physicians. Medical schools may be able to improve clinical exposure and provide more informed counselling or mentoring with respect to EM.

Elective courses for medical students during the preclinical curriculum: a systematic review and evaluation

OBJECTIVE

Preclinical medical student electives are prevalent at medical schools across the United States, but the range of electives available and their impact on medical student education are not well described in the literature. The objective of this article is to review the literature relating to preclinical medical student electives and their impact on medical student educational outcomes.

METHODS

We reviewed studies that met the following criteria: English-language articles describing preclinical US-based medical electives. We used PubMed journal databases and limited our search for the time period 1999-2014. We excluded electives based in other countries or electives designed for third or fourth year students. Data abstracted included the topic of the elective, qualitative descriptions of the electives, and any associated surveys or exam data associated with the electives. Data were synthesized using descriptive tables sorting electives by broad topic. Reported outcomes and statistical methods were analyzed to assess study quality.

RESULTS

We found a wide range of subjects taught in the form of preclinical medical school electives. We identified electives in clinical skills, the humanities, student lifestyle, specialty-specific electives, and an assortment of other miscellaneous electives. Surveys and exams administered to students showed that the electives were universally well received by students. Of the 37 electives identified, 15 electives used quantitative objective assessments, such as knowledge exams, while the remaining tended to use student self-reported results.

CONCLUSIONS

Preclinical medical student electives are prevalent at medical schools across the United States and have a significant impact on medical student education.

Improving the attractiveness of an emergency medicine career to medical students: An exploratory study

OBJECTIVES

To describe perceptions of medical students and emergency doctors towards careers in emergency medicine (EM), and to identify influences on career choice.

METHODS

A prospective, cross-sectional questionnaire study was performed in three EDs. The instrument used Likert-type items addressing: factors important in the choice of a career, factors offered by a career in EM, and opinions of EM. EM consultants and registrars and a cohort of final-year medical students participated.

RESULTS

Overall, 22 consultants, 30 registrars and 164 students completed the questionnaire (77.1% overall response). Student interest in an EM career increased from 10/161 (6.2% [95% CI 3.0-11.1%]) before, to 26/137 (19.0% [95% CI 12.8-26.6%]) after an EM attachment (P = 0.0014). The highest proportion of students chose work-life balance as being an important factor for career choice (143/163 students, 87.7% [95% CI 81.2-92.6%]). Compared with consultants and registrars, students had negative perceptions about lifestyle factors that EM offered, as well as about the future of the specialty, job security and workplace stress. Some students also preferred careers with opportunities for research, subspecialty practice, and better pay and conditions, yet perceived EM as not offering these factors. Students considered EM as an acute, procedural, public hospital specialty, with diverse patient problems and minimal continuity of care. Smaller proportions of students considered these factors important for career choice.

CONCLUSION

Increasing the attractiveness of a career in EM requires changing student perceptions of lifestyle and satisfaction benefits, access to EM subspecialties, increasing ED research, information about job security, and improved work conditions.

The effect of emergency department observational experience on medical student interest in emergency medicine

BACKGROUND

In many different health care educational models, shadowing, or observational experience, is accepted as integral to introducing students to the specifics of medical specialties.

STUDY OBJECTIVES

We investigated whether emergency department (ED) observational experiences (EDOs) affect medical students' (MSs') interest in emergency medicine (EM). Additionally, we examined how the subjective quality of clinical exposures influences this interest and the decision to recommend EDOs to other students.

METHODS

This is a survey of MSs at a Level 1 tertiary care university hospital during a 2-year period. The study focused on assessing perception of ED exposure, post-EDO change in EM interest, and decision to recommend EDOs to others.

RESULTS

The majority of MSs had a change in EM interest post-EDO and recommended EDOs. Both variables correlated to ED exposure ratings.

CONCLUSIONS

The EDO significantly influenced MS interest in EM by providing exposure to various aspects of the ED.

Motivations for a career in emergency medicine: a profile of the 1996 US applicant pool

INTRODUCTION

Although some studies have tried to assess the factors leading to choice of specialty, none have been specific to emergency medicine (EM). With a doubling of the number of EM residency programs in the past decade, an assessment of the career motivations of residents is in order.

OBJECTIVES

To identify and rank the factors that lead candidates to choose EM as a career.

METHODS

Fifty-four participating EM programs returned a total of 393 anonymous surveys completed by their 1996 National Residency Matching Program (NRMP) interviewees. The survey asked respondents to rank 12 factors on a 5-point (0-4) Likert scale.

RESULTS

Respondents ranked the 12 motivating factors in the following descending order of importance: diversity in clinical pathology, emphasis on acute care, flexibility in choice of practice location, flexibility of EM work schedules, previous work experience in EM, greater availability of EM faculty for bedside teaching, strong influence of an EM faculty advisor or mentor, relatively shorter length of training, better salaries for EM than for primary care specialties, the presence of an EM residency at the student's medical school, perception that EM residents have more time to moonlight and popularity of EM among medical students.

CONCLUSION

US applicants appear to choose a career in EM largely because of clinical factors (diversity of clinical pathology and emphasis on acute care) and practice-related factors (flexibility in practice location and schedule).