Presented By: Lillian Sims, University of Kentucky College of Medicine
Co-Authors: Mallory Johnson, University of Kentucky College of Medicine
Kimberly Jones, University of Kentucky
Sydney Short, University of Kentucky College of Medicine

Purpose 
Medical students are at risk of exposure to emotionally distressing cases during clerkships, which can result in emotional burdens when they have not had prior exposure, adequate preparation, or support. Students need to recognize this burden and cope in healthy ways. Rather than leave this burden to individuals, medical schools should prepare students for these experiences. At this institution, faculty teaching in a combined Emergency Medicine and Neurology rotation expressed interest in students' experiences outside the scope of normal course evaluations.  

Methods 
 This study entails a confidential, IRB-approved questionnaire emailed to all M3 students at a single, MD-granting institution (1 main site and 3 regional campuses) as they completed their Emergency Medicine/Neurology block. This combined block spans 6 weeks, and the survey rolls out with the associated NBME shelf exams. Providing real-time insight for clerkship directors to be able to best prepare students for the block and plan long-term curricular interventions.

Results  
Initial results from 50 students have coalesced around four consistent themes describing emotional distress rooted in 1) helplessness due to the limited student role; 2) witnessing harm or death of a patient, often for the first time; 3) resurfacing personal trauma; 4) and empathy burden. The data has identified three coping mechanism categories: 1) physical activity and hobbies; 2) wellness practices; and 3) talking to friends, family, and peers. However, students commonly identified "avoidance" as a coping strategy, underscoring the need for better preparation for healthy emotional recovery.

Conclusions 
Our real-time data reveals that students face emotional distress during their clerkships, and some do not have appropriate coping mechanisms in place to handle this burden. Clerkship directors can utilize this in-depth student feedback to make real-time adjustments to their curriculum, training environment, and resources.