Columbia Medical Students Start New Emergency Medicine Clerkship

Despite the ongoing COVID pandemic, second-year medical students at Columbia University Vagelos College of Physicians and Surgeons had a new clerkship this year among their rotations: emergency medicine. The clerkship gives students a glimpse into the inner workings of the emergency department, from the variety of pathologies seen by ED physicians on any given day to the skills needed to examine and stabilize patients in distress, while providing comfort and compassion. 

“Emergency medicine is a safety net for millions of Americans across the country,” says Devjani Das, MD, associate professor of emergency medicine and director of the clerkship in emergency medicine. “ED physicians see people regardless of their insurance status. The pandemic has only highlighted the importance of emergency medicine in the health care system.”

The emergency medicine clerkship assigns students to clinical shifts on NewYork-Presbyterian sites at the Columbia campus and at the Allen Hospital over a two-week period. Students work one-on-one with emergency medicine attending physicians during their clinical shifts, including one shift during which they work with a nurse and shadow a resident who sees critical care patients. VP&S faculty have developed didactics that include in-person teaching, case-based scenarios, simulation center sessions, hands-on ultrasound training, and asynchronous modules. 

About 60% of medical schools have an emergency medicine clerkship, according to the Association of American Medical Colleges, but Das says most of the clerkships occur in the fourth year. “The unique quality of what’s happening at Columbia is that we’re instituting this clerkship earlier in medical school during major clinical year,” Das says. “This early exposure is incredibly valuable for students to see firsthand the vital role of the emergency medicine department in the health care system.”

Planning for the clerkship began in 2019, well before the first reports of SARS-CoV-2 emerged. Faculty led the clerkship’s design and sought input from students serving on curriculum development committees. 

Safety measures during the pandemic include PPE and limiting areas of the emergency department to one student per area to avoid overcrowding. 

Brandon Vilarello, a medical student who was among the first to complete the emergency medicine clerkship, recalls arriving in the ED at 8 a.m., donning PPE, and keeping an open mind so he would be prepared for anything. He spent his eight-hour shift interviewing patients, presenting treatment proposals to physicians, and observing and assisting with procedures. 

“When one imagines an emergency, it is easy to picture chaos and uncertainty,” Vilarello says. “Something extraordinary about emergency medicine is the systematic way that ED docs approach their patients. Not only are they able to distill chaos into order, but they are exceedingly good at methodically evaluating patients for the ‘can’t miss’ diagnoses, the ones that can lead to great harm if untreated.”

For students, the vital role of emergency medicine has been complemented by the urgency of the pandemic. “The most rewarding part of this clerkship was the opportunity to step into the shoes of the front-line physicians and workers who have been battling the COVID-19 pandemic since its beginning,” says Vilarello. “This experience has given me great appreciation for what they have done. It is incredible how they witnessed COVID-19 as it went from an unknown illness to a nearly ubiquitous phenomenon while developing successful diagnostic and treatment strategies.”