Episode 12: 3rd vs 4th year Clerkship Showdown

This month we are going to find the answer to the age old question,  when should the Emergency Medicine clerkship occur, 3rd or 4th year? Here to give us some words of wisdom on this topic are Dr. David Wald, Professor of  Emergency Medicine and the Assistant Dean of Clinical Simulation at Temple University, and Dr. Matthew Tews, Professor of Emergency Medicine and Assistant Dean for Educational Simulation at the Medical College of Georgia. Alright, we don’t actually decide the best timing of the EM clerkship, but we do have an interesting discussion on the advantages and challenges associated with each.

Keep up to date on the latest CDEM Faculty podcast on Libsyn and iTunes.  

Suzana Tsao, DO

CDEM Voice – Educational Corner

                           Jigsaw Teaching Method

puzzle piece

Do you have residents and/or students that are tired of the traditional lecture format? Are you putting people to sleep with your powerpoints?  Are you simply tired of giving the same lecture over and over again on a boring topic?  Then maybe you should try using the jigsaw technique to educate.  Jigsaw is an active learning method where the learners contribute to their education and are not force-fed information.

How it works

A topic is divided into smaller inter-related topics (puzzle pieces). You assign each member of the group their specific topic (puzzle piece) and have them read on it before your session so that they become really versed in it.  On the day of the session, each member teaches their group members about their assigned topic (puzzle piece).  Once everyone has given their assigned topics (puzzle pieces), the “puzzle” is now complete.

Not clear yet? Let’s use the example that you have to give a lecture on asthma.  Rather than give a boring lecture on asthma, you decide to do a jigsaw on the topic.  You assign one member to read about  asthma triggers, one member to focus on the pathophysiology of asthma, and one member to read on treatment of asthma before the session.  You can make multiple groups of three in this fashion.  On the day of the session, each person shares what they learned with the others so that at the end, everyone knows about asthma triggers, pathophysiology, and treatment.  The puzzle is complete!

Benefits and Downsides

The pros to doing a jigsaw are that it is a less threatening teaching method for some students compared to being called on while seated amongst their peers. The jigsaw method also decreases the teacher’s dominance in teaching and allows the learners to teach themselves.  It also encourages participation since everyone has to contribute so this can help with your quiet/shy learners.  A big downside is that all your learners must come prepared prior to the session for this to work. 


Just like square dancing, you should try the jigsaw teaching method at least one to see if it suits you. It’s a great way to do some active learning and will make a boring lecture interactive.

Sundip Patel MD
Clerkship Director
Cooper Medical School of Rowan University
Camden, New Jersey

CDEM Voice – Member Highlight


Olivia Bailey MD
Clerkship Director
Associate Professor of Emergency Medicine
University of Iowa

Fun Facts about Dr. Bailey
Undergrad: University of Iowa (Go Hawkeyes!)
Medical School: University of Chicago
Residency: University of Chicago
Interesting Tidbit:  Dr. Bailey was selected to participate in the Teaching Scholars Program at University of Iowa where faculty gain advanced skills in teaching and then convey that knowledge to their department











1) What is your most memorable moment of teaching?

It’s hard to name a “most” memorable moment but there are many small moments. Memorable to me are longitudinal relationships working with individuals starting as students, continuing through residency and again as colleagues. Teaching provides a platform for career mentorship beyond the initial clerkship.

2) Who or what is your biggest influence?

When I was a medical student and resident, I was fortunate to work under seasoned physicians who allowed autonomy in my care of patients (within reason). I enjoyed this opportunity to learn by doing. I try to carry this forward in my role as an educator now.

3) Any advice for other clerkship directors?

Organization and schedule coordination can be an extreme challenge. I am fortunate to have an excellent clerkship coordinator. I would encourage others to utilize resources available, especially on the administrative side of the job.

Also, our field has many excellent resources (free and online). Students should be aware of the various podcasts and websites that they can use to suit their learning style.

4) What is your favorite part about being and educator/director?

It is energizing to work with spirited and enthusiastic students. The students are exceedingly compassionate and caring in their patient encounters.

I also enjoy the interdisciplinary learning from educators in other departments at my hospital through a Teaching Scholars program available at University of Iowa.

At the national level, the CORD conference is a great way to meet and engage with educators from other institutions as well.

5) Any interesting factoids you would like to share?

In Iowa we have incredible access to national politicians. One morning, after an overnight shift when I had just fallen asleep, my phone rang. Surprisingly, I heard it and answered only to find myself in a conversation with then candidate Obama. I think I somehow put a few almost coherent sentences together.


CDEM Faculty Podcast Episode 11: Residents as Teachers Part 1

Happy summer everyone! This episode is part one of a two part series on residents as teachers. In this episode, we are going to discuss how we prepare our residents to teach.  In part two, we will discuss creating a formal education curriculum for residents. Here to help us navigate these topics are: Page Bridges, MD, Assistant Clerkship Director and Director of Residency Training at the University of South Carolina,  Aaron Kraut MD, Associate Program Director at the University of Wisconsin, and Lauren Wendell, MD, Director of Medical Student Education at Maine Medical Center.




Keep up to date on the latest CDEM Faculty podcast on Libsyn and iTunes.  


Suzana Tsao, DO

CDEM Voice – Member Highlight


Jacob Manteuffel MD
Assistant Medical Student Clerkship Director
Department of Emergency Medicine
Henry Ford Hospital

Fun Facts about Dr. Manteuffel
Undergrad: Michigan State Univ. (Go Sparty!)
Medical School: Wayne State Univ. (Go Warriors!)
Residency: Henry Ford Hospital
Interesting Fact: President of Michigan College of Emergency Physicians
Jacob pic
                                                                   1.   What is your most memorable moment of teaching?
One of my favorite teaching moments involved a case of syncope.  I pushed my intern to broaden his differential diagnosis with regards to orthostatic hypotension, for example sepsis, ACS, PE, blood loss anemia, etc.  We reviewed the patient’s ECG and he had tachycardia and S1Q3T3 and we talked about the significance of right heart strain and how this may be PE.  The patient ended up having a submassive PE without any chest pain or shortness of breath, and my mini lecture on orthostatic hypotension was on point.  That never happens!


2.   Who or what is your biggest influence?

My clerkship directors at Wayne State University were very influential to me.  I remember my 4th year as a medical student and watching Dr. Sarkis Kouyoumjian direct his residents in floating a pacer in a symptomatic bradycardic patient.  He was cool as a cucumber and I remember thinking, I want to be like that guy.  Also Dr. Larry Schwartz was an outstanding mentor as the clerkship director at that time.

3.    Any advice for other clerkship directors?

I always try to maximize the opportunities that you have when all the students are together to emphasize how to do well on the rotation and other rotation expectations.  That generally only happens in the beginning and maybe once or twice more for didactic sessions during the rotation.  Clear communication is key.  When you are able to set expectations and encourage certain behaviors, the students get more from the rotation and there are less misunderstandings.  Emergency Medicine is unlike other specialties in that after that first day you rarely have everyone together again. 

4.   What is your favorite part about being and educator/director?

My favorite part about being clerkship director and also part of a residency program is watching the transition and growth of medical students.  It’s cool to meet a third year medical student who is interested in EM and seeking advice.  You can watch them put advice into action and excel as 4th year students.  About half of our residency classes have come from students that have rotated with us, so after 3 years of residency I have known them for a long time.  It is really rewarding to watch the students become residents and then become your colleagues. 

5.   Any interesting factoids you would like to share?

Mentoring and speaking to medical students has been a big part of my career.  I actually stepped back from the clerkship director position at Henry Ford when I became the President of the Michigan College of Emergency Physicians.  My ascent in leadership within the Michigan chapter of ACEP was largely due to work we did creating the Michigan Medical Student Council and our annual Medical Student Forum.  We understood engaging medical students was key to the success of the College, and I enjoyed the role of getting medical students involved with MCEP and emergency medicine, and I still do.


CDEM Voice – Research Column


An Introduction to Power Analysis

             Medical education research is a thriving and expanding area. However, at times there is real concern regarding the validity of quantitative studies. These issues typically occur throughout the research process, from design to manuscript. One of the more common errors deals with inadequate power.

             In medical education research, groups are evaluated based on the differences that occur during a particular event, curriculum etc. In a sample, there exists the risk of finding a difference despite there actually not being one. This is called a false positive or Type I error (alpha). In order to limit this, traditional statistics set the alpha level at 5%.   By increasing the power of the test, one can minimize this error. Medical education studies, often with their lower numbers, fall victim to this. Studies have shown that education-based research is often underpowered. It is not uncommon to see studies with less than 25 participants. While increasing the power to its maximal seems to be a logical answer, this will cause a Type II error. This is the rejection of a positive finding and instead determining that the difference is purely due to chance (null hypothesis). Overall power is typically set to 80%. This is to say that there is an 80% chance of detecting a potential difference. Another way to think about this is that there is a 20% chance of having a Type II error.

             In order to calculate the necessary power, several things must be done. Researchers need to determine how likely the design actually will identify a difference.  Then the minimal detectable effect should be identified to determine the “floor” of the study. Given the difficulty that medical education research has in sample size, knowing this allows for proper timeline and resource utilization. This will allow for increased reliability of reported data and correctly interpreted hypothesis.

             A power analysis should occur prior to data collection. This allows for appropriate sample size collection.  It also allows for potential improvement of study design and identifying covariates. Often power is calculated “post-hoc.”This is when the results and their difference are used to retrospectively calculate the appropriate power and should be avoided. It will create a one-to-one relationship with the p value i.e. a low p value will artificially provide a greater power calculation.

             It is important to have sufficient power to accurately reflect statistical significance. This will minimize Type I errors and make one’s data far more robust.  It will also serve to improve the planning and implementation of a study.  

Edward Ullman, MD
Harvard Affiliated Emergency Medicine Residency at Beth Israel Deaconess Medical Center
Boston, MA


Picho K, Artino AR. Seven Deadly Sins in Educational Research. J of Grad Med Educ. 2016;8(4):483-87.

Bakker M, van Dijk A, Wicherts JM. The rules of the game called psychological science. Perspect Psychol Sci. 2012;7(6):543-554.

Cohen J Statistical Power Analysis for the Behavioral Sciences (2nd ed) New York Academic Press 1977.


CDEM Voice – Awards Column


Listed below are the five award winners for this year’s CDEM Awards.

We would like to thank Dr. David Cheng who is chair of the CDEM Awards committee along with his team for their hard work in going through all the nominations.  If you happen to see one of these award winners, buy them a drink of their choice and pick their brains on how to become an amazing educator.

CDEM Distinguished Educator Award
Dr. Latha Ganti (Stead)

 It is with great pleasure that we present Dr. Latha Ganti (Stead) with the CDEM Distinguished  Educator Award. Dr. Ganti was in fact, one of the founding members of CDEM, where she developed the awards program to recognize educational leaders within our specialty and chaired the awards committee for several years. Dr. Ganti has been a full professor of Emergency Medicine since 2008, and a member of CDEM since its inception. To highlight a few of the significant, sustained contributions she has made to medical education over the last 16 years, she wrote her first book, BRS Emergency Medicine as an intern and signed her first book contract before she even had her MD degree. In 2000 she created an entire new book series- the very popular First Aid for the clinical clerkship series. She has also published the Atlas of Emergency Medicine Procedures. Her latest book is Neurologic Emergencies: How to do a Fast, Focused Exam for any Neurologic Complaint.

Dr. Ganti’s teaching ability has been recognized with several awards over the years including the ACEP National Faculty Teaching Award, the Mayo Medical School Excellence in Teaching Recognition, and Service recognition by the UCF College of Medicine for her preceptorship of 1st and 2nd year medical students in their Community of Practice block.  Congratulations Dr. Ganti!

CDEM Clerkship Director of the Year Award
Dr. Nathan Lewis

Dr. Lewis is an outstanding clerkship director and has created novel curriculum and provided mentorship to countless students. Dr Lewis has implemented a boot camp for Fourth Year medical students in the spring to help with their transition to residency. The Virginia Commonwealth University (VCU) EM students come in better prepared for residency after this end-of-year experience.  Dr. Lewis also provides significant mentorship at VCU. He has  advised countless EM bound M3 and M4 students. He serves on the medical school curriculum committee and is an assistant program director at VCU.  In addition to his work locally at VCU, Dr. Lewis provides a national level of mentorship through his active work with CDEM, serving on the application process improvement task force and social media and assessment committees.  He has done pioneering work in social media and is active in Free Open Access Medical Education in Emergency Medicine. He is very accomplished and we are honored to name Dr. Nathan Lewis CDEM Clerkship Director of the Year.

CDEM Innovation Award
Dr. Seth Hawkins

We are pleased to present Dr. Seth Hawkins with the CDEM Innovation Award.  Dr. Hawkins has a passion for innovation and his enthusiasm inspires the medical students and residents that rotate with him.  His enthusiasm has been exemplified by the projects, publications, and careers of those he educates and mentors.  The Carolina Wilderness EMS Externship is a month-long rotation for fourth year medical students and resident physicians that follows a unique training model envisioned by Dr. Hawkins that combines the resources of a rural/wilderness EMS system, a local community college, a community hospital system, and a major research university.  Students learn their skills from actual field providers, rather than in a classroom of lecturers.  To model authentic collaborative care, the medical students and residents receive much of their training from special operations paramedics, rescue technicians, and park rangers with decades of experience in emergency response.  While many organizations offer EMS rotations or wilderness medicine electives, none rival the Carolina Wilderness EMS Externship with its unique educational philosophy and real-life hands on experiences.  Congratulations, Dr. Hawkins!

CDEM Young Educator of the Year Award
Dr. Jamie Hess

We are pleased to present Dr. Jamie Hess with the Young Educator of the Year Award. Dr. Hess started in the role of Director of Resident Education, serving in that position for two years.  This helped establish her foundation as an educator as she has excelled in developing innovative curriculum, which has been highlighted at several national Emergency Medicine education conferences. On the most recent Graduate Questionnaire at the University of Wisconsin, Emergency Medicine was one of the highest rated clerkships and is the third most popular specialty choice. Due to her stewardship, Emergency Medicine is now a core rotation and required for all medical students at the University of Wisconsin School of Medicine. In 2016, Dr. Hess was asked to take a new leadership role as the Co-Director of the Intern Prep Course. She also assumed the role of Director for Quality, Patient Safety, and Interprofessional Education.  In addition, she oversees the Emergency Medicine Interest Group and has participated in teaching medical students point of care ultrasound.   We congratulate Dr. Jamie Hess on her well deserved award!

CDEM Young Educator of the Year Award
Dr. Trevor Pour

We are honored to present Dr. Trevor Pour the CDEM Young Educator of the Year Award. Dr Pour has made significant and ongoing contributions to the teaching and education of medical students at Mount Sinai since his time as a resident in the program.  Dr. Pour wears many hats.  He is the EM Interest Group faculty advisor and is the Course Director for Mount Sinai’s MS1 gross anatomy lab. There is rarely a shift he works without at least one student in tow. Students recognize Dr. Pour as the “go-to” faculty member in the Emergency Department. He was approached to facilitate a number of new initiatives. This included the WikiProject Medicine, an elective course for preclinical students aimed at teaching structured medical writing for a lay audience. He was also asked to become the faculty advisor for the AOA sponsored “Leaders in Health Policy” elective course which involves bringing in high-profile medical/policy thought leaders from around the nation to speak with medical students.

Dr. Pour also created two very popular electives for students; the first is an introductory course in EM for preclinical students which are predominantly taught by 4th year residents.  He also runs a popular critical care elective for students in their clinical years.  In addition, Dr. Pour and the student leaders of the Emergency Medicine interest group started a regional medical student conference in conjunction with AAEM.  Due to these many accomplishments, it is no wonder why he won this award and we congratulate him.