Sung Tzu-Ching, Shih Hsin-I, Kawaguchi Takeshi, Chi Chih-Hsien, Hsu Hsiang-Chin
School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Department of Emergency Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
J Multidiscip Healthc. 2025 Jul 7;18:3877-3890. doi: 10.2147/JMDH.S530887. eCollection 2025.
Emergency department (ED) internships are essential for developing core clinical competencies in medical students. This study evaluates the weekly progression of key competencies during a structured three-week ED internship and examines the impact of extending the program from two to three weeks. Additionally, it considers how such training supports students' readiness for multidisciplinary, team-based healthcare environments.
This retrospective longitudinal study analyzed a total of 2068 workplace-based assessment (WBA) forms collected from June 2018 to May 2020. Each WBA evaluated ten key clinical competencies: learning attitude, history taking, clinical judgment, medical knowledge, prescription, communication, patient education, literature appraisal, oral presentation, and documentation. A subgroup of 133 medical students who completed the full three-week internship with complete WBA records was included in the longitudinal analysis. Generalized Estimating Equations (GEE) modeling assessed performance trends and inter-cohort differences between 2018 and 2019.
Significant improvements were observed across all competencies, with the most notable gains in history taking, clinical judgment, communication, prescription, and documentation. Learning attitude scores increased from 4.46 (SD = 0.66) in Week 1 to 4.58 (SD = 0.58) in Week 3. Prescription and documentation improved from 3.85 and 4.17 to 4.06 and 4.32, respectively. GEE analysis confirmed significant performance gains by Week 3 (p = 0.0064). Students in 2019 outperformed those in 2018 (p = 0.0318), suggesting that curriculum refinements enhanced educational outcomes.
A structured three-week ED internship significantly enhances medical students' clinical competencies, particularly in areas fundamental to multidisciplinary care such as communication, clinical judgment, and documentation. The extended duration promotes deeper clinical immersion and fosters skill reinforcement through real-time feedback and collaborative practice. These findings underscore the importance of sustained, structured clinical experiences in preparing students to function effectively within interdisciplinary healthcare teams. Further research should investigate optimal training durations and integrative teaching strategies to support competency-based, team-oriented medical education.
急诊科实习对于医学生核心临床能力的培养至关重要。本研究评估了在为期三周的结构化急诊科实习期间关键能力的每周进展情况，并考察了将实习项目从两周延长至三周的影响。此外，还探讨了此类培训如何支持学生为多学科、团队式医疗环境做好准备。
这项回顾性纵向研究分析了2018年6月至2020年5月期间收集的总共2068份基于工作场所的评估（WBA）表格。每份WBA评估了十项关键临床能力：学习态度、病史采集、临床判断、医学知识、处方开具、沟通、患者教育、文献评估、口头报告和文档记录。纵向分析纳入了133名完成了完整三周实习且有完整WBA记录的医学生亚组。广义估计方程（GEE）建模评估了2018年和2019年之间的表现趋势和队列间差异。
所有能力均有显著提高，在病史采集、临床判断、沟通、处方开具和文档记录方面的提升最为显著。学习态度得分从第1周的4.46（标准差=0.66）提高到第3周的4.58（标准差=0.58）。处方开具和文档记录分别从3.85和4.17提高到4.06和4.32。GEE分析证实到第3周时表现有显著提高（p=0.0064）。2019年的学生表现优于2018年的学生（p=0.0318），这表明课程改进提高了教育成果。
为期三周的结构化急诊科实习显著提高了医学生的临床能力，尤其是在多学科护理的基础领域，如沟通、临床判断和文档记录。延长的实习时间促进了更深入的临床沉浸，并通过实时反馈和协作实践促进了技能强化。这些发现强调了持续、结构化的临床经验对于使学生在跨学科医疗团队中有效发挥作用的重要性。进一步的研究应调查最佳培训时长和综合教学策略，以支持基于能力、以团队为导向的医学教育。
