Dealing with the difficult student in emergency medicine

As Emergency Medicine (EM) has grown in popularity as a specialty, so has the number of medical students who participate in an EM clerkship during their school years. At present, over 160 distinct student rotations are offered in EM at US medical schools (informal review by David Manthey, 2010). Medical student educators in every specialty occasionally encounter students who have difficulties during their clerkship. Although there is little in the EM literature that describes the prevalence of the difficult learner interaction, reports from other specialties suggest that up to 15% of learners are identified as "struggling" or "problem" learners during their clinical rotation [1]. Although disagreement often exists as to what constitutes a difficult or unsuccessful learner experience, identification of problem learners is important. Unprepared or unprofessional students may become practicing physicians with inadequate knowledge of acute medical conditions and provide inappropriate care. Furthermore, these learners can go on to have significant negative impact on the medical and larger community, as it has been shown that unprofessional student behavior often correlates with future problems and formal disciplinary action [2].Any EM physician who mentors, teaches and/or trains medical students should understand and identify difficult learner interactions, and be prepared to deal with these situations appropriately. This paper describes the types of difficult learner interactions in EM, strategies for proper documentation and planning, and remediation procedures.The Emergency Department (ED) is a challenging place to train and presents a unique set of conditions that may contribute to a difficult learning experience. Problems that occur on an EM rotation may be caused by one or more factors: learner characteristics, system/administrative constraints and educator issues (Figure 1).Student-centered problems with the EM rotation can be divided into two categories: cognitiv