Specialty-Specific Entrustable Professional Activities: A Bridge to Internship.

Background Undergraduate medical education aims to prepare learners to become capable residents. New interns are expected to perform clinical tasks with distant supervision reliant on having acquired a medical degree. However, there is limited data to discuss what entrustment residency programs grant versus what the medical schools believe they have trained their graduates to perform. At our institution, we sought to foster an alliance between undergraduate medical education (UME) and graduate medical education (GME) toward specialty-specific entrustable professional activities (SSEPAs). These SSEPAs create a bridge to residency and help students structure the final year of medical school while striving for entrustability for day one of residency. This paper describes the SSEPA curriculum development process and student self-assessment of competence. Methodology We piloted an SSEPA program with the departments of Family Medicine, Internal Medicine, Neurology, and Obstetrics & Gynecology. Utilizing Kern's curriculum development framework, each specialty designed a longitudinal curriculum with a post-match capstone course. Students participated in pre-course and post-course self-assessments utilizing the Chen scale for each entrustable professional activity (EPA). Results A total of 42 students successfully completed the SSEPA curriculum in these four specialties. Students' self-assessed competence levels rose from 2.61 to 3.65 in Internal Medicine; 3.23 to 4.12 in Obstetrics and Gynecology; 3.62 to 4.13 in Neurology; and 3.65 to 3.79 in Family Medicine. Students across all specialties noted an increase in confidence from 3.45 to 4.38 in Internal Medicine; 3.3 to 4.6 in Obstetrics and Gynecology; 3.25 to 4.25 in Neurology; and 4.33 to 4.67 in Family Medicine. Conclusions A specialty-specific curriculum utilizing a competency-based framework for learners traversing the UME to GME journey in the final year of medical school improves learner confidence in their clinical abilities and may lead to an improved educational handoff between UME and GME.

Fellows' Perspective of Educational Changes in Medical Sports Medicine During the COVID-19 Pandemic.

Background As a result of the coronavirus disease 2019 (COVID-19) pandemic, graduate medical education, along with most of daily life, was disrupted. The goal of this study was to explore the experiences of fellows in primary care/medical sports medicine (MSM) and view the changes made to training programs through their eyes. Methodology A questionnaire was developed to collect qualitative and quantitative data regarding the fellow's experiences in training from March to June 2020. Fellows on the American Medical Society for Sports Medicine list of current Sports Medicine Fellows in the United States and Canada were invited to participate. Of the 329 invited, 90 (27.4%) fellows returned questionnaires. Results MSM fellows highlighted positive adaptations as well as losses to their educational programs related to the pandemic. The biggest gain reported was additional learning time, and the greatest loss was to sports and event coverage. Most fellows reported attending collaborative sessions, and they noted an increase in didactics compared to pre-pandemic levels. The largest losses were noted in event coverage and training room exposures, with smaller declines in ultrasounds, procedures, and research experiences. They also described challenges, including changing clinical roles, managing social isolation and boredom, and balancing work and family responsibilities. Conclusions Fellows identified gains, losses, and challenges due to pandemic-related changes to their fellowship programs. Fellowship directors and educators in different fields can use this understanding of the fellows' experiences to build on current resources, further develop collaborative efforts, create new educational opportunities, and provide additional support for fellow learning.

Point-of-Care Ultrasound Curriculum for Internal Medicine Residents During the COVID-19 Era: A Pilot Study.

INTRODUCTION: The use of point-of-care ultrasound (POCUS) by internal medicine physicians and residents is increasing. We present the results of a pilot study to implement a POCUS curriculum that was interrupted by the Coronavirus Disease 2019 (COVID-19) pandemic at an internal medicine residency program at a community hospital. The purpose of this study is to inquire about the attitude and interest of our medical residents in POCUS. Additionally, we also plan to examine whether a curriculum that lacks some practical aspects due to COVID-19 restrictions can still improve the residents' confidence in recognizing common POCUS applications and improve image interpretation skills. METHODS: We conducted a prospective, pre-, and post-curriculum pilot study to examine the POCUS skills of categorical internal medicine residents in Post-Graduate Years (PGY) 1 through 3 at a community hospital. The two POCUS-related skills examined were self-reported confidence level in recognizing certain POCUS examination findings and POCUS image interpretation skills. Due to social distancing guidelines, we were unable to host hands-on sessions as originally planned, but residents did receive lectures via Zoom regarding POCUS training and also organ-specific diagnoses. Three primary outcomes were measured: (1) baseline difference in confidence level between interns (PGY-1) and senior residents (PGY-2 and 3) at the beginning of the curriculum, (2) improvement in POCUS confidence level before and after the curriculum considering interns and senior residents all together and also separately, and (3) improvement in image interpretation skills before and after the curriculum. RESULTS: Of 41 residents, 23 participants completed the pre- and post-curriculum test. Of the 23 participants, 12 participants were interns, and 11 were senior residents. Overall, interns showed a statistically significant improvement in the confidence level in almost all diagnoses except pulmonary embolism (p = 0.084). For image interpretation tests, significant improvement was found only in recognizing the two signs of pneumothorax: pleural line absent sliding (X2 = 4.00, p < 0.05) and the barcode sign (X2 = 6.13, p < 0.05). The pre-curriculum confidence level questionnaire included a question about residents' interest in learning POCUS during residency. It showed that the vast majority of residents (21 residents [91%]) are either extremely or mostly interested in POCUS. Most of our residents (18 [78%]) did not have formal exposure to POCUS during medical school. CONCLUSION: A POCUS curriculum that lacks hands-on workshops and longitudinal image saving and reviewing due to the COVID-19 pandemic restrictions did not improve the residents' image interpretation skills, although the confidence levels of the interns statistically improved. After the pandemic, we plan to implement the full curriculum and examine whether it will improve the residents' image acquisition and interpretation skills.

Training Military Psychiatrists to Adapt and Overcome: How COVID-19 Highlighted the Unique Flexibility of Military Psychiatry in Training and in the Fleet.

PURPOSE OF REVIEW: Born out of necessity, military medicine continues to find itself at the forefront of medical innovation. This generation of military physicians has never previously been challenged with continuing to provide top notch medical support to servicemembers in a variety of operational settings in the midst of a global pandemic. While military medicine has always been able to uniquely meet the educational goals of residency training, COVID-19 brought new challenges to the forefront. RECENT FINDINGS: While the threat presented by COVID-19 was different from the historical battlefield threats and challenges that have given birth to military medicine, it was nevertheless ready to pivot and adjust course, focusing on how to best meet the medical needs of the military patient population in an ever-changing geopolitical environment while continuing to meet and exceed the educational standards that training programs are held to. Historically and currently, mental health remains one of the most common reasons that servicemembers are evacuated from combat zones. The COVID-19 pandemic provided an opportunity for modern military psychiatry to showcase its ability to adjust the educational focus in certain areas of residency training to prepare the next generation of military psychiatrists to be able to face the newest threat to force wellness.