Evidence Based Medicine in the Emergency Medicine Clerkship

Teaching evidence-based medicine in the clinical years of medical schools can be challenging. There is no single standardized approach or best practice as to how to incorporate this practice into the clinical rotations. At our institution, all mandatory clinical rotations are expected to incorporate an evidence-based medicine exercise, the specifics as to how this is accomplished is left up to the discretion of the clerkship leadership. In an attempt to provide a more uniform experience we developed a standardized assignment for all students completing their required fourth year emergency medicine (EM) rotation. The standardized approach to this assignment also provides the faculty an opportunity to be more consistent in evaluating and grading the assignment and providing feedback to the students. The assignment is worth 5% of the end of rotation grade and is evaluated based on a rubric that we have developed internally. For this assignment, we developed case standardized vignettes focusing on 4 commonly encountered clinical conditions; Case A-Cervical spine injury, Case B-Syncope, Case C-Community acquired pneumonia, Case D-Pulmonary embolism. When applicable, the specific cases included laboratory data, en electrocardiogram or diagnostic imaging. The clinical conditions for which the vignettes were developed were identified by the authors because they rare relevant to the practice of emergency medicine and because the students would be able to identify a validated clinical decision rule to help answer the question associated with their assigned case. Cases should be able to easily be developed to adapt this assignment to other clinical specialties. Case vignettes were standardized in their format and ended with a dichotomous lead in question focusing on a single decision point, either the need for further diagnostic work up or the need for hospital admission. At the beginning of each rotation block, students are randomly assigned to one of the 4 cases and are responsible for submitting their assignment in a word document format by the middle of the 2nd week of the rotation. Specific guidelines for this assignment, instructions for submitting the assignment and the actual cases are included with this submission. It is important to remind the learners that they should review original published research which will support and guide their clinical decision making. They should use only original research to address the case and question; they should not cite consensus statements, guidelines, expert opinion or book chapters. They should identify only ONE article to write up as part of their submission. Remember, the article should properly address the assigned case and question. When identifying an article, keep in mind the clinical question and the population that is being addressed.