An Entrustable Professional Activity (EPA)-Based Framework to Prepare Fourth-Year Medical Students for Internal Medicine Careers.

The purpose of the fourth year of medical school remains controversial. Competing demands during this transitional phase cause confusion for students and educators. In 2014, the Association of American Medical Colleges (AAMC) released 13 Core Entrustable Professional Activities for Entering Residency (CEPAERs). A committee comprising members of the Clerkship Directors in Internal Medicine and the Association of Program Directors in Internal Medicine applied these principles to preparing students for internal medicine residencies. The authors propose a curricular framework based on five CEPAERs that were felt to be most relevant to residency preparation, informed by prior stakeholder surveys. The critical areas outlined include entering orders, forming and answering clinical questions, conducting patient care handovers, collaborating interprofessionally, and recognizing patients requiring urgent care and initiating that care. For each CEPAER, the authors offer suggestions about instruction and assessment of competency. The fourth year of medical school can be rewarding for students, while adequately preparing them to begin residency, by addressing important elements defined in the core entrustable activities. Thus prepared, new residents can function safely and competently in supervised postgraduate settings.

Training and assessment of ECG interpretation skills: results from the 2005 CDIM survey.

BACKGROUND: Despite published consensus-based statements on assessment of ECG interpretation skills, studies and curricula regarding the training needed to obtain basic ECG interpretation skills are lacking. These consensus statements have focused on attaining competency in ECG interpretation during postgraduate training; however, recommendations regarding assessment of competency in the undergraduate curriculum are not discussed. PURPOSE: The purpose is to describe the current methods of teaching and assessing ECG interpretation skills across institutions on the 3rd-year internal medicine (IM) clerkship. METHOD: In 2005, the Clerkship Directors in Internal Medicine surveyed its institutional members. Twelve questions on the survey dealt with ECG interpretation. Descriptive statistics, chi-square, and Mann-Whitney U were used for analysis. RESULTS: Eighty-eight of 109 members (81%) responded to the survey. Overall, 89% of institutional respondents feel that ECG interpretation is an important clinical skill for medical students with 92% indicating that instruction occurs on the IM clerkship. Lectures (75%) and teaching rounds (44%) were the most cited methods of instruction. Most schools spend 1 to 6 hr during the IM clerkship on formal ECG instruction. Over 63% indicated that ECG interpretation skills are assessed during the clerkship. The most common assessment methods were written exam (40%) and OSCE (23%). CONCLUSIONS: Objective data regarding attainment and assessment of basic ECG interpretation competency in the undergraduate curriculum are lacking; our report provides preliminary descriptive data regarding ECG teaching and assessment on the 3rd-year IM clerkship. Further studies are needed to determine the ideal method of instruction and evaluation of this important clinical skill.

Training and assessment of CXR/basic radiology interpretation skills: results from the 2005 CDIM Survey.

BACKGROUND: Despite published literature demonstrating deficiencies in chest radiograph (CXR)/basic radiology interpretation skills of 4th-year medical students, studies and subsequent curricula regarding the training needed to obtain these skills are lacking. Terms such as clinical exposure and radiology teaching have been used to describe the experience for these basic interpretive skills, but best practice methods of delivery, let alone common methods, have yet to be defined. PURPOSE: The objective is to describe the current methods of teaching and assessing CXR/basic radiology interpretation skills across institutions on the 3rd-year internal medicine (IM) clerkship. METHODS: In 2005, the Clerkship Directors in Internal Medicine (CDIM), an international organization representing U.S. and Canadian medical schools, surveyed its institutional members. Twelve questions on the survey dealt with X-ray interpretation. RESULTS: Eighty-eight of 109 members (81%) responded to the survey. Overall, 81% of respondents felt that CXR interpretation is an important clinical skill for medical students. Seventy-six percent indicated that instruction in these skills occurs on the IM clerkship. The most cited methods of instruction were lectures (56%) and teaching rounds (48%). Most schools spent on average of 2 to 4 hr during the IM clerkship on formal radiology instruction. Only 33% indicated that radiology interpretation skills are assessed during the clerkship. The most common assessment methods were written examination (19%) and OSCE (19%). CONCLUSION: Substantive data regarding attainment and assessment of CXR/basic radiology interpretation skills in the undergraduate curriculum are lacking. Our study provides preliminary descriptive data regarding CXR instruction and assessment on the 3rd-year IM clerkship.