Study design, setting, and participants
This is a prospective study analyzing student electronic logbooks (e-Portfolio). The study was conducted in the Emergency Medicine (EM) clerkship of the College of Medicine and Health Sciences of the UAEU during 2016/2017 academic year. The EM clerkship is a 4-week rotation for senior (sixth year) medical students. The content of the EM clerkship curriculum was adopted from the Society for Academic Emergency Medicine [11] and International Federation for Emergency Medicine [12] and consists of 11 chief complaints (abdominal pain, altered mental status, cardiac arrest and arrhythmias, chest pain, fever in a child, gastrointestinal bleeding, headache, poisoning, respiratory distress, shock, and major trauma) and five procedures (airway management, cardiopulmonary resuscitation and arrhythmia management [CPR-AM], suturing and wound care, focused assessment with sonography on trauma [EFAST], rapid ultrasonography for shock and hypotension [RUSH]).
Teaching, learning, and assessment activities are directed by a clerkship director and implemented collaboratively with core-faculty members and senior EM residents. Teaching sessions include up to date pedagogies such as flipped classroom, team-based learning, and case-based learning instead of didactic faculty lectures. Skill sessions are held in the College simulation and skills center. Simple medical skills manikins are used for airway and suturing practices as well as high-fidelity manikins for CPR-AM practices. Normal human models are used for ultrasound training. Assessments consist of weekly multiple-choice question exams in team-based learning activities, oral case presentations, clinical shift performance evaluations by supervisors, a final multiple-choice question exam, and an objective-structured clinical examination.
The students complete their clinical shifts in two teaching hospitals in our city, Tawam Hospital and Al Ain Hospital. Both hospitals treat more than 115,000 emergency patients every year. Tawam Hospital implements an ACGME-I accredited EM residency program. During the 2016/2017 academic year, there were five groups of 9 to 17 students each, with a total of 76 final year medical students (47 females, 19 males). Six out of ten clinical shifts for each medical student were completed in Tawam Hospital, and each clinical shift period was 9 h long. The shift hours were also similar in the Al Ain Hospital. Students complete three clinical shifts in the resuscitation unit, four in the urgent care area, two in the fast-track area, and one in the pediatric unit. Students work different shift times in the units; day time (08:00–17:00), three shifts; prime time (13:00–22:00), four shifts; evening time (15:00–24:00), two shifts; and night time (24:00–09:00), one shift.
Data collection and analysis
SharePoint was used as the e-Portfolio medium of EM clerkship. Students access this website securely from their computers or mobile devices by entering their specific credentials [13]. Students are asked to complete a minimum of 33 chief complaints and 33 procedures during the 4-week period. At the beginning of the clerkship, the clerkship director oriented the students on how to fill in the e-Portfolio. Students were informed to enter the main/chief complaint of the patients and most critical/life or organ-saving procedures first into the e-Portfolio. They were free to log all chief complaints and procedures they encounter on patients.
Data in the logbooks included descriptive information of patients such as matriculation number, age and gender, chief complaint seen, and procedure exposed by the student, hospital, unit, shift time, student involvement level, and some specific clinical areas related to their patients. Student involvement had three levels: (1) observation alone (observation with minimal activity), (2) partial involvement (first assistant with up to 50% activity), and (3) full involvement (start to finish care with more than 50% activity).
Students were supervised by an attending physician or a senior resident during the clinical shifts. Students were informed to seek help from the supervisors when deciding on data entry of any of the fields, especially the involvement level. Supervisors were the final authority to accept, modify, or cancel the logbook entries according to their own judgment. Supervisors also evaluated each student for their clinical performance at the end of clinical shifts.
This online platform provides continuous monitoring of student logbook entries by the clerkship director and offers feedback opportunities to students. The clerkship director used the log results in the individual feedback sessions which were held in the second week of the clerkship. Results of the e-Portfolio were evaluated at the end of the clerkship.
Comparison of continuous data of two groups was performed using the Mann–Whitney U test. Comparison of categorical data was performed using Pearson chi-squared test or Fisher’s exact test as appropriate. A P value of less than 0.05 was accepted as significant. Data were analyzed using Statistical Package for the Social Sciences (IBM-SPSS version 24.0, Chicago, IL, USA).