The trainee in difficulty

Letters

CJEM 2002;4(1):3-6

To the editor:

I congratulate Robert McGraw and Sarita Verma on their excellent review¹ of "The trainee in difficulty" in the July 2001 issue of CJEM. The editorial comments by Tim Allen were also timely and helpful.² Several key suggestions have been made that will help us all in our efforts to make the teaching environment in our emergency departments as effective as it can be.

Medical school enrollment is expanding nationally. Emergency medicine is increasingly becoming a core element of many medical school curricula. Our EDs are taking on a greater role as the setting where medical students gain their exposure to clinical medicine. We therefore clearly have an expanding role in not only teaching but in identifying the student in difficulty. Our role is one of both identification and, at times, remediation of students when they fail to meet the standards set.

The ED has several features that make it a setting particularly well suited to teaching and evaluation. I am very concerned though that with the national trend to overcrowding, delays in patient care and resource availability that is often less than ideal, the conditions for optimal teaching are eroding. We muct continue to apply pressure wherever and whenever we can to develop solutions when our departments are blocked and understaffed. We must do this as patient advocates and as educators.

With respect to identifying students in difficulty, feedback loops and early reporting of students whose performance falls short of what we expect are key requirements in our role. A further way in which we can improve our vigilance and consistency is the suggestion that students be encouraged to ask for feedback at an appropriate time at the end of each clinical shift. This critical step can become an expectation whenever staff physicians work with medical students. If shift evaluation forms are used, students can provide these at the same time. This can be an ideal time for assessment and feedback while the events of the shift remain fresh in the minds of both students and staff.

Thank you again to the authors of these articles. Their insights can be helpful to us all and can improve the way we evaluate medical students. Their suggestions can improve our contribution as teachers and will help us to develop a unique approach to medical undergraduate education in which we can all take pride.

Bruce Fleming, MD 
Associate Dean, Student Affairs 
Faculty of Medicine 
University of British Columbia 
Associate Head 
Department of Emergency Medicine 
Vancouver Hospital 
Vancouver, BC

References

1. McGraw R, Verma S. The trainee in difficulty. CJEM 2001;3(3):205-8.
2. Allen T. Daily evaluation cards for trainees: "Make it so" [commentary].CJEM 2001;3(3):228-9.