This document describes a study that used expert educator shifts to assess medical students on emergency medicine milestones. During the shifts, students were directly observed by attending physicians as they cared for patients, and were assessed on 10 milestones. Results showed that students who participated rated direct observation, feedback, and the educational experience more highly compared to previous students. The study concluded that expert educator shifts can effectively assess competency-based milestones and help prepare students for residency. Future directions involve developing an advanced clinical track to teach residency-level milestones prior to graduation.

1. An Expert Educator Teaching
Shift Used as a Method to
Assess Milestones in Students
Nicholas Kman, Cindy Leung, David
Hartnett, Sarah Greenberger, Daniel
Bachmann, David Way, Sorabh
Khandelwal, Daniel Martin

2. No Disclosures
 Nicholas Kman
 Cindy Leung
 David Hartnett
 Sarah Greenberger
 Daniel Bachmann
 David Way
 Sorabh Khandelwal
 Daniel Martin
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3. Background
 24 competency-based milestones for fourth-year
medical students completing their emergency medicine
(EM) clerkships were recently published.
3 Santen, et al. “Medical Student Milestones in Emergency Medicine”.

4. Background
 Our institution implemented a competency-based
curriculum in 2011 called the Lead.Serve.Inspire (LSI).
 In response to both low numbers of evaluations of
direct observation of competence requirement &
development of milestones, our clerkship implemented
an expert educator shift.
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5. Educational Objectives
 To use an expert educator teaching shift as a
way to improve direct observation of
competence and assessment of the milestones
in EM.

6. Curricular Design
 An expert educator (3 total) completed two 4 hour
teaching shifts per month with two to four 4th year
medical students.
 For the first three hours, the group focused on clinical
care of ED patients during which students were
encouraged to pick up new patients and present them
to the teaching attending physician, similar to a
conventional shift.
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7. Curricular Design
 Each student was directly observed and assessed by
faculty during the patient encounter on a
predetermined set of objectives corresponding with 10
medical student milestones in EM (Table 1).
 Remaining hour for direct individual feedback &
informal didactic session (addition to core medical
student lecture series).
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8. Table 1
List of medical student milestones assessed during an
expert educator shift.
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Milestone Description
Recognizes abnormal vital signs.
Recognizes when a patient is unstable requiring immediate intervention.
Performs and communicates a reliable, comprehensive history and physical exam.
Performs and communicates a focused H&P which effectively addresses the chief complaint
and urgent patient issues.
Constructs a list of potential diagnoses based on chief complaint and initial assessment.
Formulates basic diagnostic and therapeutic plans based on a differential diagnosis.
Establishes rapport with and demonstrates empathy toward patients and their families.
Demonstrates behavior that conveys caring, honesty, patient confidentiality, genuine interest
and tolerance when interacting with a diverse population of patients and families.
Demonstrates basic professional responsibilities such as timely reporting for duty,
appropriate dress, conference attendance, and timely completion of clerkship documents.
Effectively listens and communicates with patients and their families.

9. Preliminary Results
 Compared program evaluation results between
graduates of 2014 and the current class on 6
measures related to direct observation and
satisfaction:
 Key: Strongly Disagree.....Strongly Agree
 Q1. A faculty member personally observed me taking
a history
 Q2. A faculty member personally observed me
performing a physical examination
 Q3. Faculty members provided me with sufficient
feedback on my performance
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10. Preliminary Results
 Compared program evaluation results between
graduates of 2014 and the current class on 6
measures related to direct observation and
satisfaction:
 Key: Not Important.....Very Important
 Q4. Rate the importance of the Expert Educator Shift
 Q5. Rate the importance of Direct Observation
 Key: Poor.....Excellent
 Q6. Rate the quality of your overall educational
experience
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11. Results
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12. Impact/Effectiveness
 Improvement in student perception of direct
observation of competence exercise and have
demonstrated that an expert educator shift can be
utilized to directly assess 10 of the recently published
medical student milestones for EM.
 An expert educator shift with direct observation of
competence can be further utilized to assess additional
competency based milestones in undergraduate
medical education.
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13. Future Directions: Advanced Clinical Track
 Develop an advanced clinical track to teach
residency level 1 and level 2 residency milestones
prior to graduation
 Supplement to the medical student milestones
evaluated in the clerkship
 Prepare medical students for success in EM
residency
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14. Questions?
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