August of 2023 marked the launch of the Duke University School of Medicine (SOM) novel “PIONEER” curriculum, a 16-week multidisciplinary outpatient experience, providing exposure to multiple specialties earlier in their clinical training for better understanding of the roles of various settings within the healthcare system. The Department of Emergency Medicine (EM) was called upon to host all 2nd year Duke SOM students—approximately 120 each year—in the emergency department (ED) as part of a formal rotation. Dr. John Purakal, serving as the first PIONEER EM clerkship director, worked alongside Ms. Tracey Reynolds (PIONEER Coordinator) to design a schedule to account for doubling the total number of learners in the ED annually. This feat would not be possible without the collaboration of the Director of Undergraduate Medical Education (UME), Dr. Erin Leiman, and the Physician Assistant Student Education Director, Joel Stoia, PA.
In addition to traditional EM learning experiences, students also benefit from Dr. Purakal’s implementation of a new hybrid multidisciplinary shift, giving students insight to the invaluable roles that respiratory therapists and pharmacists play in the ED. This hybrid shift also provides practical insight to Dr. Leiman’s interprofessional-specific lectures and faculty-facilitated reflection sessions that occur over the course of the rotation. Additionally, Dr. Purakal has created EM-specific lecture topics for the students’“trailblazing” lectures, which EM faculty lead. The new curriculum is the first of its kind in the country, and further shows our department’s commitment to being at the forefront of emergency medicine education.
Fourth Year Medical Students
In addition to the PIONEER students, the Department continues to host fourth year medical students in two courses. The first is the Duke EM Sub internship (sub I), which is for students pursuing an EM residency in the upcoming match. We enroll both Duke students as well as visiting students who participate in clinical shifts, weekly didactics (with the residents as well as dedicated student lectures), and other events with the goal of instructing these students about our program and about emergency medicine in general. This year, for the 2024–2025 application season, we will be hosting 9 Duke students and 7 visiting students.
Dr. Leiman is very appreciative of the faculty and residents helping her this year, including Drs. Rivera and Ruderman as well as Nina Angeles, Denise Elizondo, and the chief residents, Amna Nawaz, Sekar Novika, and Carmen Estrada Huerta. This team has collaborated to develop an engaging and expansive curriculum.
The second course is the elective course which is for students pursuing other specialties. Generally, this course is similar to the sub I, however, these students do not complete a presentation at the end. We tend to host more elective students later in the fall, winter, and early spring and this well-established course is an opportunity to provide these students with additional preparation for their upcoming intern year.
Additional Second Year Medical Students
In addition to the PIONEER students, we also have 2nd-year medical students on the primary care leadership track (PCLT) that participate in winter/spring.These students concurrently work in clinical shifts at Duke Urgent Care facilities. These students do not attend weekly didactics.
Other Duke Medical Students
Our emergency medicine faculty also serves as mentors to other Duke medical students who want to explore emergency medicine as a possible career choice. This may take the form of 1st year medical students trying to gain first exposure to this field or it could be 3rd year medical students participating in ED shifts as part of their continuity care experience.
Physician Assistant Students
Our department hosts students from the Duke Physician Assistants Program as part of their training. Our PA education leadership organizes these student schedules and lectures, and the PA group at large precepts these students during their clinical shifts. Our faculty do contribute to these students learning on cases where the PA collaborates with faculty on management.
Additional Learners
The Duke Emergency Department also hosts a variety of other non-medical students throughout the year in shadowing shifts. Many of these students are Duke undergraduate students, who as part of their affiliation with the Duke Office of Health Professions Advising, explore potential future careers in medicine. Other students may be participating in other Duke-specific pipeline programs or may be from other areas around the health system and general Duke campus.