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SPECIAL CONTRIBUTION

Clerkship Directors in Emergency Medicine:Statement of PurposeDavid A. Wald, DO, David E. Manthey, MD, Michelle Lin, MD, Douglas S. Ander, MD, JonathanFisher, MD

Abstract

The Academy of Clerkship Directors in Emergency Medicine (CDEM) provides a forum for the collabo-

rative exchange of ideas among emergency medicine (EM) medical student educators, a platform for the

advancement of education, research, and faculty development, and establishes for the first time a

national voice for undergraduate medical education within our specialty. CDEM plans to take a leading

role in providing medical student educators with additional educational resources and opportunities for

faculty development and networking. CDEM will work to foster the professional growth and develop-

ment of undergraduate medical educators within our specialty. The advancement of undergraduate edu-

cation within our specialty and beyond will come primarily from the support, hard work, and dedication

of the educators. To accomplish our goals, at the departmental, medical school, and national level, we

must come together to further promote our specialty across the spectrum of undergraduate medical

education. The first step has already been taken with the formation of the Academy of CDEM.ACADEMIC EMERGENCY MEDICINE 2008; 15:856859 2008 by the Society for Academic Emergency

Medicine

The Academy of Clerkship Directors in Emergency

Medicine (CDEM), formed in 2008, provides a

forum for the collaborative exchange of ideas

among emergency medicine (EM) medical student edu-

cators and a platform for the advancement of education,

research, and faculty development and establishes for

the first time a national voice for undergraduate medicaleducation within our specialty. CDEM is the first Acad-

emy within the Society for Academic Emergency Medi-

cine (SAEM) membership and views its mission as being

aligned with other national organizations that have set

forth to promote and champion the cause of undergrad-

uate medical education in their respective specialties.17

Our mission statement is presented in Table 1. Member-

ship in CDEM is open to all categories of SAEM mem-

bers. More information on the development of the

Academy structure can be found on the SAEM website

(http://www.saem.org/saemdnn/), in the September

October issue of the SAEM Newsletter Presidents mes-

sage, and on the CDEM website (http://www.saem.org/

CDEM).

The idea of CDEM in its present form was conceived

during an informal meeting of medical student educa-

tors in New Orleans in October 2006. Following themeeting, a needs assessment survey was developed and

distributed to EM clerkship directors and medical stu-

dent educators across the country. From these targeted

surveys, a number of equally important broad areas of

need were identified. Medical student educators in our

specialty have reported the need for additional oppor-

tunities faculty development, networking, fostering

educational research, the development of educational

resources, and a unified voice at the national level.

Even in its infancy, CDEM has started to address

some of these areas of need by working with the Coun-

cil of Emergency Medicine Residency Directors (CORD-

EM) to develop a medical student educator track at the

2007 and 2008 CORD-EM Academic Assembly. CDEM

will continue to develop educational sessions for future

CORD meetings, and will be submitting didactic pro-

posals for future SAEM annual meetings. To further

enhance the EM clerkship experience, CDEM members

are working on a resource for clerkship directors and

medical students entitled The Emergency Medicine

Clerkship Primer: A Manual for Medical Students. This

manual will focus on the needs of medial students as

they prepare for their EM clerkship. Similar manuals

ISSN 1069-6563 2008 by the Society for Academic Emergency Medicine

856 PII ISSN 1069-6563583 doi: 10.1111/j.1553-2712.2008.00207.x

From the Department of Emergency Medicine, Temple Univer-

sity School of Medicine (DAW), Philadelphia, PA; the Depart-

ment of Emergency Medicine, Wake Forest University School

of Medicine (DEM), Winston-Salem, NC; the Department of

Emergency Medicine, UCSF-San Francisco General Hospital

(ML), San Francisco, CA; the Department of Emergency Medi-

cine, Emory University School of Medicine (DSA), Atlanta, GA;

and the Department of Emergency Medicine, Beth Israel

Deaconess Medical Center (JF), Boston, MA.

Received April 25, 2008; accepted June 13, 2008.

Address for correspondence and reprints: David A. Wald, DO;

e-mail: waldda@tuhs.temple.edu.

8/9/2019 CDEM Statement of Purpose

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have been developed by medical student educators in

internal medicine and obstetrics and gynecology.8,9 For

both medical students and medical student educators,

CDEM has developed a website that will house a host

of educational material under one umbrella. In addition,

in the upcoming year, members of CDEM will be revis-

ing the Medical Student Educators Handbook.

For decades, EM medical student educators have

greatly impacted the educational experiences of medical

students. These educators comprise medical school and

residency faculty, EM physicians who practice in aca-

demic affiliate training sites, and others who practice inthe community hospital setting. Presently, there are

more than 170 allopathic and osteopathic medical

schools. As of 2008, there are 143 allopathic and

37 osteopathic EM residency training programs in the

United States and, among them, many hundreds of EM

medical student educators. Across the country, these

educators are involved in many aspects of undergradu-

ate medical education including: clinical, procedural,

and simulation skills training; curriculum development;

clinical clerkship; and medical school administration,

along with their role in advising and mentoring medical

students applying to EM residency training programs.

The CDEM plans to take a leading role in providingthese educators with additional educational resources

and opportunities for faculty development and net-

working. CDEM will work to foster the professional

growth and development of undergraduate medical

educators within our specialty. By doing so, our career

satisfaction and longevity will undoubtedly be

enhanced. In the initial development stages, CDEM, will

focus on: 1) further supporting EM clerkship directors

and therefore reducing the rapid turnover, 2) enhanc-

ing the quantity and quality of EM education in medical

schools across the country, and 3) fostering collabora-

tion with organizations both within and outside of EM

that support undergraduate medical education.

Clerkship directors across all specialties play a vitalrole both in the academic department and within the

school of medicine. Fostering, promoting, and support-

ing the role of the clerkship director at the departmen-

tal and medical school level is paramount for a

successful career and enhanced job satisfaction for fac-

ulty who view undergraduate medical education as a

career, not merely a stepping stone.1012 Recently, a

multidisciplinary group of medical student educators

published recommendations for the resources and sup-port necessary for clerkship directors to be successful

as academic faculty.13 This collaborative statement from

the Alliance for Clinical Education estimates that the

time allocation required for a clerkship director to per-

form clerkship administration and other related educa-

tional activities is equivalent to 25%50% of a full-time

equivalent. Although an EM representative was not

part of this collaborative effort, the recommended

guidelines could be applicable to EM clerkship directors

of mandatory or high-volume clinical rotations. Similar

statements outlining the expectations of clerkship direc-

tors have been developed by medical student educators

in internal medicine and psychiatry.14,15 A document

outlining the expectations of the EM clerkship directordoes not yet exist. Partly because of this, the relative

infancy of our specialty, and the prior lack of a unified

voice at the national level, the role of the EM clerkship

director has not been traditionally looked at in the same

light as clerkship directors in other fields of medicine.

On average, EM clerkship directors are between 5

and 10 years younger, more likely to be junior faculty

at the clinical instructor or assistant professor rank,

and more likely receive less protected time for clerkship

administration than our counterparts in other special-

ties.1622 In addition, clerkship directors in other fields

of medicine have on average held their present position

for 58 years. This is in stark contrast to our specialty,where it was reported in 2005 that 45% of EM clerkship

directors were in their present position for only

12 years and fewer than 25% have held their position

longer than 5 years.16 In this study, EM clerkship direc-

tors also report receiving on average only 2.7 hours per

week of a clinical load reduction, and 51% reported that

they had no clinical hours set aside to perform clerk-

ship administrative duties. It is unclear as to why there

is such a turnover in this position, although the lack of

protected time for clerkship administration and other

scholarly pursuits may play a role. Further research is

necessary to identify issues related to job satisfaction

and career longevity among this academic group.Medical student educators have also stated that the

roles of the clerkship director and residency program

director are and should be viewed as comparably valu-

able positions.13 With this in mind, clerkship directors of

mandatory and high-volume EM rotations deserve

equivalent protected time from clinical duties to allow

for clerkship administration, medical student teaching,

and participation in other scholarly pursuits, such as

educational research. However, at the present time in

our specialty, this is not necessarily the case. EM clerk-

ship directors are younger, more likely to be junior fac-

ulty, and more likely receive significantly less protected

time when compared to EM residency program direc-

tors.16,23 Medical student educators should be embracedwithin an academic department and our specialty, similar

Table 1Clerkship Directors in Emergency Medicine (CDEM)

Mission Statement:

The Academy of CDEM is composed of emergency medicineclerkship directors and medical student educators who arecommitted to enhancing medical student education in emer-gency medicine.

Our Mission Is:1. To advance the education of medical students as it per-tains to the specialty of emergency medicine and acute caremedicine.2. To serve as a unified voice for emergency medicine clerk-ship directors and medical student educators.3. To provide a forum for emergency medicine clerkshipdirectors and medical student educators to communicate,share ideas, and generate solutions to common problems.4. To foster undergraduate medical education research.5. To foster the professional development and career satis-faction of emergency medicine clerkship directors and medi-cal student educators.6. To foster relationships with other organizations that pro-mote medical education.

ACAD EMERG MED September 2008, Vol. 15, No. 9 www.aemj.org 857

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to residency program directors, whose job qualification

and description is delineated in the Accreditation Coun-

cil for Graduate Medical Education (ACGME) program

requirements for graduate medical education in EM.24

Furthermore, based on a recently published SAEM fac-

ulty salary survey, residency program directors work on

average 16.7 clinical hours per week.25

A second focus for CDEM revolves around enhanc-ing EM undergraduate education in all U.S. medical

schools. For many years, medical student educators

have called for an increased emphasis on EM in the

undergraduate curriculum.2631 However, as of 2005,

only one-third of medical schools have incorporated a

mandatory EM clerkship into the clinical years.28,32 An

EM clerkship offers a unique educational experience

for medical students and can play an important role in

filling curricular gaps in areas such as acute care,

public health, resuscitation, and procedural skills.3335

EM medical student educators are also increasingly

becoming more involved with various aspects of

the undergraduate curriculum including objective struc-

tured clinical examinations, clinical and proceduralskills training, and the use and application of simulation

technology.

Despite the varied and sometimes limited exposure to

our specialty, EM remains an ever-popular career

choice among graduating medical students. EM is the

fourth most common specialty that U.S. medical stu-

dents choose to enter, behind internal medicine, family

medicine, and pediatrics. From 1986 to 2002, EM

showed the most consistent increase in the number of

U.S. medical students matching across all specialties.36

EM has shown a steady increase in the number of resi-

dency positions offered in the national residency

matching program, representing 6.3% of all Postgradu-ate Year 1 positions offered in the 2008 match.37 To fur-

ther the mission of promoting excellence in EM

training for medical students, CDEM will also focus

efforts on supporting the growth of EM as a mandatory

clinical experience for medical students.

A third focus for CDEM includes fostering close rela-

tionships with other organizations that promote medi-

cal student education. CDEM is already working closely

with CORD and SAEM and is looking forward to work-

ing with other EM professional organizations. Outside

of EM, a number of other medical specialties, including

family medicine, internal medicine, obstetrics and gyne-

cology, pediatrics, psychiatry, neurology, and surgery,have formed organizations that support medical student

educators and undergraduate medical education within

their respective specialty.17 Each of these organizations

are at the forefront of their specialty, developing educa-

tional resources and providing faculty development for

medical student educators. In 1992, a multidisciplinary

group, the Alliance for Clinical Education, was

formed.38 Its members include representatives of the

seven medical student educator organizations listed

above. Its mission is to foster collaboration across spe-

cialties to promote excellence in the clinical education

of medical students. The collaborative effort of the

seven constituent organizations has led to the develop-

ment of a number of high-quality educationalresources.13,39,40 CDEM has initiated preliminary dis-

cussions with the Alliance for Clinical Education

regarding future collaboration.

In summary, the advancement of undergraduate edu-

cation within our specialty and beyond will come primar-

ily from the support, hard work, and dedication of the

educators. To accomplish our goals at the departmental,

medical school, and national level, we must come

together to further promote our specialty across thespectrum of undergraduate medical education. The first

step has already been taken with the formation of the

Academy of CDEM. We welcome your input to shape

this organization from those who support its mission.

References

1. Society of Teachers of Family Medicine. Available

at: http://www.stfm.org/index_ex.html. Accessed

Apr 8, 2008.

2. Clerkship Directors in Internal Medicine. Available

at: http://www.im.org/cdim. Accessed Apr 8, 2008.

3. Association of Professors in Gynecology and

Obstetrics. Available at: http://www.apgo.org/home.Accessed Apr 8, 2008.

4. Council on Medical Student Education in Pediatrics.

Available at: http://www.comsep.org. Accessed Apr

8, 2008.

5. Association of Directors for Medical Student Educa-

tion in Psychiatry. Available at: http://www.admsep.

org. Accessed Apr 8, 2008.

6. Consortium of Neurology Clerkship Directors.

Available at: http://www.aan.com/go/education/

clerkship/consortium. Accessed Apr 8, 2008.

7. Association for Surgical Education. Available at: http://

www.surgicaleducation.com/mc/page.do. Accessed

Apr 8, 2008.

8. Alper EJ, Appel JL, De Fer TM, et al. Primer to the

internal medicine clerkship, a guide produced by

the clerkship directors in internal medicine. 2004

Clerkship Directors in Internal Medicine. Washing-

ton, DC. Available at: http://www.im.org/AAIM/

Pubs/primer.htm. Accessed Apr 8, 2008.

9. Espey EL, Erickson SS, Hammoud MM, et al. The

obstetrics and gynecology clerkship, your guide

to success, authored by the association of professors

of gynecology and obstetrics undergraduate medical

education committee. 2006 Association of Profes-

sors of Gynecology and Obstetrics. Crofton, MD.

Available at: http://www.apgo.org/binary/Clerkship%

20Primer%20Online%20Version.pdf. Accessed Apr8, 2008.

10. Marcdante KJ, Kliegman RM. Promoting clerkship

directors: The importance of evidence. J Pediatr.

2002; 141:12.

11. Elnicki DM. Why what we do matters. Am J Med.

2001; 110:67680.

12. Elnicki DM, Hemmer PA, Udden MM, et al. Does

being a clerkship director benefit academic career

advancement: results of a national survey. Teach

Learn Med. 2003; 15:214.

13. Pangaro L, Fincher RM, Bachicha J, et al. Expecta-

tions of and for clerkship directors: a collaborative

statement from the alliance for clinical education.Teach Learn Med. 2003; 15:21722.

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