title: Are fourth-year medical students as prepared to manage unstable patients as they are to manage stable patients?
abstract: OBJECTIVE
  To evaluate the fourth-year medical student's assessment and management of an unstable patient.
  
  
  METHODS
  The authors compared the performance of fourth-year medical students in a clinical performance examination (CPX) across a spectrum of simulated stable conditions as compared with a case of ST-elevation myocardial infarction (STEMI). All fourth-year medical students at the Medical University of South Carolina participated in an eight-station CPX. Student performance was graded as the percentage of correct steps performed according to checklists developed through a modified Delphi technique. Repeated analysis of variance was performed to compare performance on different stations. Data are reported as mean (standard deviation), and P < .05 was considered significant.
  
  
  RESULTS
  A total of 143 fourth-year medical students participated in the study. The percentage of correct actions performed in the STEMI station was 47.8 (9.5), which was significantly lower than all other stations (P < .001). There was no difference in overall performance between any of the other stable encounters. Students performed significantly worse in the physical and management/treatment components of the STEMI station, as compared with history, differential diagnosis, labs/tests, and diagnosis.
  
  
  CONCLUSIONS
  Fourth-year medical students were less prepared to manage a simulated STEMI case compared with a range of nonacute conditions. Given the prevalence of coronary artery disease and the necessity of interns to be equipped to handle emergent situations, this deficiency should be addressed in undergraduate medical curricula.
authors.affiliation: Dr. McEvoy is vice chair for educational affairs, program director, and associate professor, Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee. Dr. DeWaay is assistant professor and associate vice chair for education, Department of Internal Medicine, Division of General Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina. Dr. Vanderbilt is assistant professor and director of assessment and evaluation for the Center of Health Disparities, School of Medicine, Virginia Commonwealth University, Richmond, Virginia. Dr. Alexander is an anesthesiology resident, Vanderbilt University, Nashville, Tennessee. Ms. Stilley is research and academic information systems analyst, College of Medicine, Medical University of South Carolina, Charleston, South Carolina. Ms. Hege is director, Center for Clinical Evaluation and Teaching, College of Medicine, Medical University of South Carolina, Charleston, South Carolina. Dr. Kern is associate professor, Department of Family Medicine, and associate dean for curriculum-clinical science, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McEvoy
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Dewaay
authors.forename: Allison
authors.initials: A
authors.lastname: Vanderbilt
authors.forename: Louise A
authors.initials: LA
authors.lastname: Alexander
authors.forename: Marna C
authors.initials: MC
authors.lastname: Stilley
authors.forename: Maura C
authors.initials: MC
authors.lastname: Hege
authors.forename: Donna H
authors.initials: DH
authors.lastname: Kern
mesh_terms: D000704:Analysis of Variance; D060050:Angina, Stable / Q000175:diagnosis*; D057189:Checklist; D002983:Clinical Competence; D003198:Computer Simulation; D003937:Diagnosis, Differential; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D010808:Physical Examination / Q000379:methods; D013337:Students, Medical; D055815:Young Adult