Are Fourth-Year Medical Students as Prepared to Manage Unstable Patients as They Are to Manage Stable Patients?

Abstract

Purpose To evaluate the fourth-year medical student's assessment and management of an unstable patient. Method The authors compared the performance of fourth-year medical students in a Clinical Performance Examination (CPX) across a spectrum of simulated stable conditions as compared to a case of ST-elevation myocardial infarction (STEMI). All fourth-year medical students at the Medical University of South Carolina participated in an 8-station CPX. Student performance was graded as the percentage of correct steps performed according to checklists developed through a modified Delphi technique. Repeated analysis of variance was performed to compare performance on different stations. Data are as mean (standard deviation [SD]) and P<.05 was considered significant. Results A total of 143 fourth-year medical students participated in the study. Correct actions performed in the STEMI station was 47.8 (9.5), which was significantly lower than all other stations (P<.001). There was no difference in overall performance between any of the other stable encounters. Students performed significantly worse in the physical and management/treatment components of the STEMI station, as compared to history, differential diagnosis, labs/tests, and diagnosis. Conclusion Fourth-year medical students were less prepared to manage a simulated STEMI case compared to a range of non-acute conditions. Given the prevalence of coronary artery disease and the necessity of interns to be equipped to handle emergent situations, this deficiency should be addressed in undergraduate medical curricula.

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