Teaching the RAPID approach at the start of emergency medicine clerkship: An evaluation

Background: The RAPID approach (Resuscitation, Analgesia and assessment, Patient needs, Interventions, Disposition) was developed as an approach to managing emergency department patients. It is a mental checklist to help trainees provide comprehensive care, addressing issues in priority. Its impact on trainee performance has not been assessed. Methods: Forty-two clerkship students were enrolled, with 21 students in each group. They received or did not receive the teaching intervention on an alternate basis. Students were assessed through daily encounter cards, a case presentation, a self-assessment form, a prerotation case (case E), and a sixcase short-answer exit examination (cases A to F) with case E repeated. Case E was designed specifically to assess students' ability to provide comprehensive care. Fourteen students participated in focus groups. Results: Students in the intervention group had significantly higher exit examination case E scores (11.67 of 14 v. 10.26 of 14, p = 0.008) and improvement in their case E scores from pre- to postrotation (1.82 v. 0.26, p = 0.006). There were no significant differences in the other outcome measures. Intervention group students made positive comments around analgesia, addressing nonmedical needs and counseling on health promotion during focus groups. Conclusions: Students exposed to the RAPID approach at the start of their emergency medicine rotation performed better on the one component of the written examination for which it was designed to improve performance. Students found it to be a useful mental checklist for comprehensive care, possibly addressing the hidden curriculum. Emergency medicine educators should consider further study and careful implementation of the RAPID approach.