Background: Preclinical medical students study pathologic concepts but have limited exposure to clinical medicine. It is thus unclear which chief complaints (CC) the third year medical student (M3) is prepared to evaluate in the acute care setting. We hypothesized that M3s on a mandatory Emergency Medicine (EM) clerkship would best evaluate patients with CCs of Abdominal Pain (AP) and Chest Pain (CP) due to common physical exam instruction and geographic anatomy.
Methods: This was an observational, retrospective review of 123 students rotating in three EM clerkship blocks from July 2017-June 2018 at the University of Kentucky. Curriculum committee determined CCs were AP, Dyspnea (Dys), Trauma (Tr), CP, and Altered Mental Status (AMS). Additional CCs were categorized as Other. Standardized Entrustable Professional Activity (EPA) scoring on a scale of 1-4 (graded 65%, 75%, 85% and 95% respectively) for Differential Diagnosis (DDx), Diagnostic Plan (DxP) and Oral Presentation (OP) were reviewed for every CC-based evaluation. Overall mean scores were reported and p-values were calculated using one-way ANOVA.
Results: Data was collected on N=2917 CC assessments. 81 assessments did not receive grades and were excluded. 1 assessment was excluded due to no faculty name. A remaining 2835 assessments from 123 students were analyzed. CC grades across clerkship blocks showed AP=87.06 (SD=5.74, N= 643, p<0.102), Dys=86.57 (SD=6.16, N= 205, p<0.323), Tr=87.35 (SD=5.94, N= 255, p<0.390), CP=86.68 (SD=5.68, N= 297, p<0.040), AMS=86.72 (SD=5.71, N=411, p <0.218), and Other=86.72 (SD=6.01, N=1020, p< 0.001). Subgroup analysis of EPAs by CC showed DDx in AP, CP, and Other reached statistical significance, but DxP and OP failed to do so. DDx scores for AP showed 11.5%, 58.9%, and 29.5% scored 2, 3, and 4 respectively (N=643, p<0.045). CP showed 12.5%, 60.3%, and 27.3% (N=297, p<0.048). Other showed 13.9%, 56.5%, and 29.6% (N=1020, p<0.001).
Conclusions: M3s scored highest on CCs of AP and Tr, though improvement of scores longitudinally was only statistically significant for CP and Other. In regard to DDx, EPA grades suggest students are better prepared for this element of patient care in regard to AP, CP, and Other. Additional study is needed to address generalizability of these results as well as factors that influence student EPAs in DDx versus DxP and OP.