SPECIAL CONTRIBUTION

Clerkship Directors in Emergency Medicine:

Statement of Purpose
David A. Wald, DO, David E. Manthey, MD, Michelle Lin, MD, Douglas S. Ander, MD, Jonathan
Fisher, 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; 15:856–859 ª 2008 by the Society for Academic Emergency
Medicine

T
he 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 medical
education 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.1–7
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
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.
(http://www.saem.org/saemdnn/), in the September ⁄
October issue of the SAEM Newsletter President’s 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 the
meeting, 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 ª 2008 by the Society for Academic Emergency Medicine

856 PII ISSN 1069-6563583 doi: 10.1111/j.1553-2712.2008.00207.x
ACAD EMERG MED • September 2008, Vol. 15, No. 9 • www.aemj.org
Table 1
Clerkship Directors in Emergency Medicine (CDEM)
Mission Statement:
The Academy of CDEM is composed of emergency medicine
clerkship directors and medical student educators who are
committed 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 care
medicine.
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 clerkship
directors 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.
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 in
the 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 providing
these 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 vital
role both in the academic department and within the
857
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.10–12 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 director
does 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.16–22 In addition, clerkship directors in other fields
of medicine have on average held their present position
for 5–8 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
1–2 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 embraced
within an academic department and our specialty, similar
858 Wald et al.
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.26–31 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.33–35
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 procedural
skills 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.1–7 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 educational
resources.13,39,40 CDEM has initiated preliminary dis-
• CLERKSHIP DIRECTORS IN EM: STATEMENT OF PURPOSE
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 the
spectrum 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.
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