Milestones for Internal Medicine Sub-interns

Roles and Responsibilities of Medicine Subinternship Directors : Medicine Subinternship Director Roles

BACKGROUND

The internal medicine (IM) subinternship (also referred to as acting internship) plays a crucial part in preparing medical students for residency. The roles, responsibilities, and support provided to subinternship directors have not been described.

OBJECTIVE

We sought to describe the current role of IM subinternship directors with respect to their responsibilities, salary support, and reporting structure.

DESIGN

Nationally representative, annually recurring thematic survey of IM core clerkship directors with membership in an academic professional association as of September 2017.

PARTICIPANTS

A total of 129 core clinical medicine clerkship directors at Liaison Committee on Medical Education fully accredited U.S./U.S.-territory-based medical schools.

MAIN MEASURES

Responsibilities, salary support, and reporting structure of subinternship directors.

KEY RESULTS

The survey response rate was 83.0% (107/129 medical schools). Fifty-one percent (54/107) of respondents reported overseeing both core clerkship inpatient experiences and/or one or more subinternships. For oversight, 49.1% (28/53) of subinternship directors also reported that they were the clerkship director, 26.4% (14/53) that another faculty member directed all medicine subinternships, and 18.9% (10/53) that each subinternship had its own director. The most frequently reported responsibilities for the subinternship directors were administration, including scheduling, and logistics of student schedules (83.0%, 44/53), course evaluation (81.1%, 43/53), and setting grades 79.2% (42/53). The modal response for estimated FTE per course was 10-20% FTE, with 33.3% (16/48) reporting this level of support and 29.2% (14/54) reporting no FTE support.

CONCLUSIONS

The role of the IM subinternship director has become increasingly complex. Since the IM subinternship is critical to preparing students for residency, IM subinternship directors require standard expectations and adequate support. Future studies are needed to determine the appropriate level of support for subinternship directors and to define essential roles and responsibilities.

The New Internal Medicine Subinternship Curriculum Guide: a Report from the Alliance for Academic Internal Medicine

The internal medicine (IM) subinternship has been a long-established clinical experience in the final phase of medical school deemed by key stakeholders as a crucial rotation to prepare senior medical students for internship. Medical education has changed greatly since the first national curriculum for this course was developed in 2002 by the Clerkship Directors in Internal Medicine (CDIM). Most notably, competency-based medical education (CBME) has become a fixture in graduate medical education and has gradually expanded into medical school curricula. Still, residency program directors and empirical studies have identified gaps and inconsistencies in knowledge and skills among new interns. Recognizing these gaps, the Association of Program Directors in Internal Medicine (APDIM) surveyed its members in 2010 and identified four core skills essential for intern readiness. The Association of American Medical Colleges (AAMC) also published 13 core entrustable professional activities (EPAs) for entering residency to be expected of all medical school graduates. Results from the APDIM survey along with the widespread adoption of CBME informed this redesign of the IM subinternship curriculum. The authors provide an overview of this new guide developed by the Alliance for Academic Internal Medicine (AAIM) Medical Student-to-Resident Interface Committee (MSRIC).

Redefining the Acting Internship in the Era of Entrustment: One Institution's Approach to Reforming the Acting Internship

Creating a Core Entrustable Professional Activities (Core EPA) curriculum requires a longitudinal approach. Current curricular efforts have focused primarily on the pre-clerkship and clerkship phases of training; however, the role of the Acting Internship (AI) has not been explored. The AI experience offers opportunities for students to have enhanced clinical responsibility, demonstrate proficiency, and allows for assessment of Core EPAs that are beyond the focus of clerkships. We share our experience developing an interdepartmental AI experience designed to assess designated Core EPAs and highlight tensions that should be considered when incorporating an AI experience into a longitudinal Core EPA-oriented curriculum.

Internal Medicine Residency Program Directors' Views of the Core Entrustable Professional Activities for Entering Residency: An Opportunity to Enhance Communication of Competency Along the Continuum

PURPOSE

To examine internal medicine (IM) residency program directors' (PDs') perspectives on the Core Entrustable Professional Activities for Entering Residency (Core EPAs)-introduced into undergraduate medical education to further competency-based assessment-and on communicating competency-based information during transitions.

METHOD

A spring 2015 Association of Program Directors in Internal Medicine survey asked PDs of U.S. IM residency programs for their perspectives on which Core EPAs new interns must or should possess on day 1, which are most essential, and which have the largest gap between expected and observed performance. Their views and preferences were also requested regarding communicating competency-based information at transitions from medical school to residency and residency to fellowship/employment.

RESULTS

The response rate was 57% (204/361 programs). The majority of PDs felt new interns must/should possess 12 of the 13 Core EPAs. PDs' rankings of Core EPAs by relative importance were more varied than their rankings by the largest gaps in performance. Although preferred timing varied, most PDs (82%) considered it important for medical schools to communicate Core EPA-based information to PDs; nearly three-quarters (71%) would prefer a checklist format. Many (60%) would be willing to provide competency-based evaluations to fellowship directors/employers. Most (> 80%) agreed that there should be a bidirectional communication mechanism for programs/employers to provide feedback on competency assessments.

CONCLUSIONS

The gaps identified in Core EPA performance may help guide medical schools' curricular and assessment tool design. Sharing competency-based information at transitions along the medical education continuum could help ensure production of competent, practice-ready physicians.

Milestones for medical students completing a clinical genetics elective

PURPOSE

We are not aware of any competency-based evaluation method that is specifically designed for a genetics elective for medical students. Here, we aimed to create a milestone template to improve evaluation and to use the feedback from the template to improve the elective.

METHODS

Through an iterative process using feedback from eight medical students and eight attendings, we crafted a milestone template for the medical student genetics rotation. A "scavenger hunt" of activities was developed to address several gaps discovered through this process.

RESULTS

All participants felt that the milestone template was complete for the student level and that it improved evaluation. In response to faculty feedback, we modified the evaluation process such that several evaluators rated students in only selected domains. Scavenger hunt activities were designed to address five domains that the students reported to be inadequately covered.

CONCLUSION

Developing a milestone template has taken us a step closer to meaningful assessment of students completing the genetics elective and simultaneously allowed us to strengthen the elective. Meaningful elective experiences in genetics that provide individual feedback within a learner-centered assessment of progress and flexible out-of-classroom activities may contribute to lifelong learning and interest in genetics and genomics.Genet Med 19 2, 236-239.