As a medical student, do you remember your EM clerkship experience and whether you saw a wide variety of patient chief complaints? Did your fellow medical student on the EM clerkship rotation, who was going into Orthopedics, seem to only see patients with orthopedic complaints?

In a study in Academic EM in 2008 at Harbor-UCLA Medical Center, medical students were provided a list of 10 chief complaints which they had to see during their 4-week rotation.

These chief complaints were:

  1. Abdominal pain
  2. Acute coronary syndrome
  3. Asthma
  4. Diabetic ketoacidosis / hyperglycemia
  5. Headache
  6. Laceration
  7. Orthopedic injury
  8. Pediatric fever
  9. Traumatic injury
  10. Vaginal bleeding

When I last spoke with Dr. Wendy Coates (one of the authors), this study arose because she found that medical students, if left on their own, will NOT see a variety of patients during the EM clerkship rotation.

This was a prospective, non-randomized, case-control study. The control group (n=18) included students who saw whichever patients they desired during the EM clerkship rotation. The test group (n=24) included students who were assigned to see each of the 10 listed chief complaints during rotation.


Using a difference in means analysis, the test group students showed greater exam score improvement (post-test score minus pre-test score), compared to the control students. What was interesting was this exam tested a broad range of topics including and beyond the 10 assigned chief complaints.

Some ideas

After reading this article, I find myself thinking about whether a similar approach might be applied in other settings.

  1. I think this would be terrific idea for interns (PGY-1 residents) on the EM rotation. Many interns from a variety of departments rotate through the Emergency Department to gain a broad experience in managing acute medical conditions. Although I find that most interns are open to seeing a variety of chief complaints, several naturally gravitate towards only seeing patients with complaints which are directly relevant to their specialty. This checklist of chief complaints would encourage interns to gain a more balanced and broad EM knowledge base.
  2. Another idea — there could be a completely different checklist of chief complaints for students who are rotating on their second EM rotation. These chief complaints could include more advanced topics such as: eye complaint, acute back pain, drug of abuse, and seizure/stroke.

Do you have any ideas or thoughts?

Lampe CJ, Coates WC, Gill AM. Emergency medicine subinternship: does a standard clinical experience improve performance outcomes? Acad Emerg Med. 2008 Jan;15(1):82-5.

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD