Dissecting the Medical Student Approach to Chest Pain: A Cross-Sectional Study Focusing on Aortic Dissection

Background and purpose: To understand if medical students consider rarer, but highly fatal conditions, such as acute aortic dissection, when assessing chest pain. Methods:An online virtual clinical case (in two 'stages') was distributed to medical students. Stage one presented a chest pain scenario, asking participants to give relevant questions, clinical findings, investigations, and differential diagnoses. In the second stage, students were given a detailed case, populated with the aortic dissection ‘red flags’ and asked to re-evaluate their differential diagnosis and investigations. A total of 113 students in their final two years of study, across six United Kingdom (UK) medical schools, were accepted into the study. Results: During stage one, students were able to assess chest pain with radiation (93%), character (83%), and onset (89%), which were asked commonly. However, students failed to enquire on severity (38%) and important risk factors such as connective tissue disorders (4%) and hypertension (46%), or clinical signs such as blood pressure differences (5%). Myocardial infarction (97%) and pulmonary embolism (78%) were the most considered differentials with acute aortic dissection only considered by 31%. However, in stage two, 73% recognised the acute aortic dissection and 76% were able to request a CT thorax. Conclusions: Students effectively consider myocardial infarction and pulmonary embolism when assessing chest pain, but often fail to examine acute aortic dissection. This could lead to delayed treatment of a cataclysmic event and may be due to a deficiency in diagnostic synthesis rather than a lack of knowledge. More can be done to ensure these conditions form part of their diagnostic workup.