Medical Student Self-Assessment Narratives: Perceived Educational Needs During Fourth-Year Emergency Medicine Clerkship

Background: The educational needs of medical students in the 4th-year of training are not well defined in the literature. Purpose: The specific aim of this investigation is to characterize the perceived educational needs of 4th-year medical students during an Emergency Medicine clerkship. Methods: This was a thematic analysis of informed self-assessment narratives. The writings were performed by medical students during an Emergency Medicine clerkship from July 2010 through May 2011. Themes and subthemes that emerged were assessed for frequency of occurrence. Results: Qualitative analysis of 203 narratives revealed 13 themes and 55 subthemes. Patient care (50%), history taking (44%), and physical examination (29%) were the themes most commonly noted as strengths. Medical decision making/plan of care (44%), differential diagnosis (37%), presentation skills (32%), and knowledge base (27%) were the themes most commonly noted as weaknesses. All themes were described as strengths by some students and weaknesses by others; however, trends were apparent in the analysis. Conclusions: Fourth-year medical students rotating on an Emergency Medicine clerkship perceive an educational need to improve medical decision making/plan of care. Self-assessment narratives reveal trends in strengths and weaknesses but also highlight the importance of recognizing students as unique learners with individualized needs.