Deliberate apprenticeship in the Pediatric Emergency Department improves experience for third-year students.

Introduction: The Pediatric Emergency Department (PED) provides medical students with learning in a high-volume, fast-paced environment; characteristics that can be stressful for new students. Shadowing can improve transitioning, yet this alone does not facilitate students' development of independent medical care competencies. This study evaluates if third-year medical students' deliberate apprenticeship with senior residents increases students' comfort and patient exposure in the PED.

Methods: This study took place over the 2011-2012 academic year, and study participants were all third-year medical students during their pediatric clerkship rotation. This was a prospective educational intervention assigning students to randomized control blocks of deliberate apprenticeship (DA) intervention or control. DA students were paired with a senior resident who oriented and worked with the student, while control students were unpaired. All students completed a 20-question structured survey at shift end, which included questions about their perception of the learning environment, comfort with, and number of patient care responsibilities performed. We used independent Mann-Whitney and t-tests to compare experiences between the groups. Statistical significance was defined as p<0.05. We used the constant comparative method to qualitatively analyze students' comments.

Results: Response rate was 85% (145/169). Students also rated on 5-point Likert-scale their level of comfort with defined aspects of working in the PED. DA students (n=76) were significantly more comfortable obtaining histories (4.2 versus 3.8) and formulating differential diagnoses (3.9 versus 3.4). DA students also performed more physical exams (2.9 versus 2.4). We categorized themes from the qualitative analysis of the students' comments about their PED experience. The titles for these themes are as follows: PED provides a good learning experience; uncertainty about the medical student's role in the PED; third-year medical students compete with other learners for teaching attention; opportunities provided to medical students for inclusion in patient care; personal knowledge deficits limit the ability to participate in the PED; PED pace affects learning opportunities.

Conclusion: DA constitutes a feasible approach to the clinical learning environment that increases students' patient care experiences and may ease transitioning for undergraduate medical students to new clinical environments.