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

Objective: To determine whether emergency medicine (EM)-bound and non-EM-bo und senior medical students on the EM subinternship have a uniform experien ce with respect to number and acuity of patients seen and procedures perfor med. Methods: Prospective observational analysis of patient diagnosis and p rocedures recorded in logs by students at a public teaching hospital over 1 2 consecutive months. Logs were reviewed blindly and assigned an acuity lev el based on predetermined criteria. Preselected procedures were categorized as general or surgical and tallied. Identity, specialty choice, gender, an d month of rotation for each student were identified. Results: Seventy of 7 4 students completed logs. On average, 34 EM-bound students saw 59.82 patie nts (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 an alysis showed EM-bound students saw more patients than non-EM- bound studen ts, performed more surgical procedures, and saw higher-acuity patients (p = 0.004; 0.009; 0.016). Multivariate analyses controlled for EM specialty, g ender, 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 sho wed EM specialty and gender were significant (p = 0.010; 0.038). Conclusion s: In an EM subinternship, experience was variable between EM-bound and non -EM-bound students. Male students saw lower-acuity patients. The EM-bound s tudents saw more patients, higher-acuity patients, and performed more proce dures than non-EM-bound cohorts. Emergency medicine educators responsible f or medical education should be aware of these differences.