The importance of internal medicine internship for young doctors' training

Abstract

Introduction: Internal Medicine is a “broad base” specialty where students are confronted with various clinical problems, often complex, essential for training in clinical reasoning and the acquisition of medical professional competence. The educational value of training in this specialty in early internship has never been objectively evaluated. The script concordance test (SCT) assesses the ability of doctors to prioritize assumptions in clinical situations with a degree of uncertainty. With no single correct answer, the result is expressed in “agreement” with the responses of a panel of experts. We present a pilot study evaluating by SCT, the educational value of internship in internal medicine at the beginning of the third cycle. Methods: We present a prospective multicenter controlled study from six departments of internal medicine in France. The SCTs were created and calibrated on medical students, young doctors and experts. The calibrated series of tests was then used to evaluate young doctors making their first internship in internal medicine at the beginning and the end of their first semester. The control group is represented by different interns that arrive in internal medicine after the first 6 months of training in another specialty. Results: A series of 60 versatile questions of general and internal medicine was created and then validated by a panel of 18 internal medicine experts (E) with more than 10 years of experience. Our study population (SP1) consists of 18 interns at the beginning of the semester. 14 completed the test at the end of the semester (SP2). The control group consists of 14 interns at the beginning of the second semester (CP). We note a progression of our study population at the end of the study (SP2) M = 48.1 SD= 3.9 range [41.4; 55.04] as compared to the beginning of the rotation (SP1) M = 45.96 SD= 4.7 range [36.4; 56.3]. The experts (E) were at 53.3 SD4 [44; 60]. Nonparametric statistic using the Friedman test confirms the significant difference between the beginning and the end of the internal medicine rotation as compared to the expert's results: SP1 mean rank 1.92, SP2 mean rank 2.5, E mean rank 3.67, χ2 = 14.7 p = 0.02.The control population of interns having completed a medical rotation other than internal medicine (CP) had results similar to those preceding the internal medicine rotation M = 45.46 SD = 3.8 range [35.5; 48.5]. Conclusion: The Internal Medicine rotation seems to improve the clinical reasoning training capacity of young doctors. SCT is able to evaluate its role in the formation of young doctors, but a larger study may be necessary for validation of our results.