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Sick vs Not Sick – Teaching Students in Triage

May 19, 2021

Written by Clay Smith

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Medical students felt more confident in rapidly assessing patients after a single shift in ED triage in which they repeatedly performed quick screening exams.

Why does this matter?
A chief goal of the clinical years of medical school is to learn how to quickly spot which patients are sick and which are not sick. But this takes a lot of practice, which means students need to see a lot of patients. Every day in triage, dozens or even hundreds of patients stream into our EDs. What if we put our students out there?

Sick or not sick?
Fourth year medical students in an EM clerkship did one shift in triage with a dedicated teaching attending. The encounter was structured to allow the students to rapidly assess numerous patients under direct observation, discuss a brief differential diagnosis and plan, and get real-time feedback from the attending. There were 21 students who took a pre- and post-shift survey. Overall, they were much more comfortable performing a rapid assessment after the triage shift. This type of educational study is based on a student’s self assessment of their own performance, is highly subjective, and may not be that meaningful for patient centered outcomes or for assessing learning. However, I am covering this paper because I think this is a good concept. In the past, on my triage shifts, I saw some triage patients, read all triage notes and charts, entered orders on every patient, saw all the psych patients, and decided which patients got what bed. But now we have a new triage model in which I try to see every single patient who comes through. It is a bit stressful. However, the experience is rich – namely, seeing a boatload of patients in a single shift in rapid-fire sequence, some of whom have concerning histories, vital sign abnormalities, ECG findings, GSW drop-offs, stroke-like symptoms needing immediate stroke alert activation, or they just look sick. While this study may not be a big game changer, the idea it conveys is really good and suggests it’s a valuable experience for students.

Teaching Rapid Assessment Skills in Triage for the Emergency Medicine Clerkship. J Emerg Med. 2021 Mar 29;S0736-4679(21)00106-2. doi: 10.1016/j.jemermed.2021.02.005. Online ahead of print.

What are your thoughts?