Whether the “July effect” is real or simply lore, for medical students transitioning to residencies, this summer month is tremendously stressful. Internal medicine program directors have expressed concern regarding new interns’ skill sets and the lack of skill set standardization, according to survey results that appeared in the March issue of Academic Medicine.
The survey results note that other studies echoed these concerns, identifying several common struggles for new interns, including a lack of self-reflection and improvement, poor organizational skills, and underdeveloped professionalism.
The survey asked internal medicine program directors to determine which competencies or skills they expected from new medical school graduates. The competencies given the highest priority were:
- Knowing when to seek assistance
- Communicating with nurses and nurse triage
- Time management
- Communicating in a culturally sensitive manner
- Information management and prioritization
Oral presentation and effective communication skills also were highly ranked. Respondents infrequently listed medical knowledge and procedural experience.
Undergraduate medical education (UME) and graduate medical education (GME) are in the process of addressing these potential areas of deficiency. On the UME side, the Association of American Medical Colleges is developing its core entrustable professional activities (EPA), a list of 13 general skills that all entering residents should be able to perform on day one of residency without supervision, regardless of specialty. Some EPAs include providing oral presentations, participating as a contributing member of an interprofessional team and forming clinical questions.
Meanwhile, the Accreditation Council for Graduate Medical Education is focusing on the GME side by developing a competency-based education continuum called the Next Accreditation System. It’s also moving toward defined developmental milestones by specialty for residents in its Milestones Project. Already, at least two specialties (pediatrics and internal medicine) have defined EPAs that can be used as a basis for workplace assessment and transition into practice.
Soon, physicians of the future will be immersed in a continuum of professional growth, transitioning seamlessly from medical student to resident to practicing physician. At least, that’s the hope of medical educators who recently met in a consortium meeting of the AMA’s Accelerating Change in Medical Education initiative, held last month at the University of Michigan Medical School.
The consortium is working through the challenges of developing a flexible, competency-based progression through medical school. For example, the University of California Davis School of Medicine is placing students into ambulatory care settings at the very start of their medical education, promoting seamless integration between their medical education and entry into clinical practice.
“There are big disconnects between UME and GME,” Rebecca Minter, MD, associate professor of surgery at the University of Michigan, said at the consortium meeting. “We need to try to better link those different time periods in our training structure.”
