Volume 16, Issue 6, November 2015.
Katherine Hiller, MD, MPH
Introduction: There is great variation in the knowledge base of Emergency Medicine (EM) interns
in July. The first objective knowledge assessment during residency does not occur until eight months
later, in February, when the American Board of EM (ABEM) administers the in-training examination
(ITE). In 2013, the National Board of Medical Examiners (NBME) released the EM Advanced Clinical
Examination (EM-ACE), an assessment intended for fourth-year medical students. Administration of
the EM-ACE to interns at the start of residency may provide an earlier opportunity to assess the new
EM residents’ knowledge base. The primary objective of this study was to determine the correlation
of the NBME EM-ACE, given early in residency, with the EM ITE. Secondary objectives included
determination of the correlation of the United States Medical Licensing Examination (USMLE) Step 1
or 2 scores with early intern EM-ACE and ITE scores and the effect, if any, of clinical EM experience
on examination correlation.
Methods: This was a multi-institutional, observational study. Entering EM interns at six residencies
took the EM-ACE in July 2013 and the ABEM ITE in February 2014. We collected scores for the EMACE
and ITE, age, gender, weeks of clinical EM experience in residency prior to the ITE, and USMLE
Step 1 and 2 scores. Pearson’s correlation and linear regression were performed.
Results: Sixty-two interns took the EM-ACE and the ITE. The Pearson’s correlation coefficient
between the ITE and the EM-ACE was 0.62. R-squared was 0.5 (adjusted 0.4). The coefficient of
determination was 0.41 (95% CI [0.3-0.8]). For every increase of one in the scaled EM-ACE score,
we observed a 0.4% increase in the EM in-training score. In a linear regression model using all
available variables (EM-ACE, gender, age, clinical exposure to EM, and USMLE Step 1 and Step 2
scores), only the EM-ACE score was significantly associated with the ITE (p<0.05). We observed
significant colinearity among the EM-ACE, ITE and USMLE scores. Gender, age and number of
weeks of EM prior to the ITE had no effect on the relationship between EM-ACE and the ITE.
Conclusion Given early during intern year, the EM-ACE score showed positive correlation with ITE.
Clinical EM experience prior to the in-training exam did not affect the correlation.
Volume 16, Issue 6, November 2015.
Amanda L. Webb, MS, et al.
Introduction: Medical educators in recent years have been using social media for more
penetrance to technologically-savvy learners. The utility of using Twitter for curriculum content
delivery has not been studied. We sought to determine if participation in a social media-based
educational supplement would improve student performance on a test of clinical images at the end
of the semester.
Methods: 116 second-year medical students were enrolled in a lecture-based clinical medicine
course, in which images of common clinical exam findings were presented. An additional, optional
assessment was performed on Twitter. Each week, a clinical presentation and physical exam image
(not covered in course lectures) were distributed via Twitter, and students were invited to guess the
exam finding or diagnosis. After the completion of the course, students were asked to participate in a
slideshow “quiz” with 24 clinical images, half from lecture and half from Twitter.
Results: We conducted a one-way analysis of variance to determine the effect Twitter participation
had on total, Twitter-only, and lecture-only scores. Twitter participation data was collected from the
end-of-course survey and was defined as submitting answers to the Twitter-only questions “all or
most of the time”, “about half of the time”, and “little or none of the time.” We found a significant
difference in overall scores (p<0.001) and in Twitter-only scores (p<0.001). There was not enough
evidence to conclude a significant difference in lecture-only scores (p=0.124). Students who
submitted answers to Twitter “all or most of the time” or “about half the time” had significantly higher
overall scores and Twitter-only scores (p<0.001 and p<0.001, respectively) than those students who
only submitted answers “little or none of the time.”
Conclusion: While students retained less information from Twitter than from traditional classroom
lecture, some retention was noted. Future research on social media in medical education would
benefit from clear control and experimental groups in settings where quantitative use of social media
could be measured. Ultimately, it is unlikely for social media to replace lecture in medical curriculum;
however, there is a reasonable role for social media as an adjunct to traditional medical education.
