Clerkship Directors In Internal Medicine Research Articles

How Internal Medicine Clerkship Directors Are Using Entrustable Professional Activities: A National Survey Study.

In the present assessment environment in undergraduate medical education at U.S. medical schools, the prevalence and implementation of Entrustable Professional Activities (EPAs) in internal medicine (IM) clerkships are not well understood. To describe the prevalence and approach to EPA use in U.S. IM clerkships. Cross-sectional, nationally representative survey of core IM clerkship directors. One-hundred forty IM clerkship directors at Liaison Committee on Medical Education-accredited U.S./U.S. territory-based allopathic medical schools with membership in the Clerkship Directors in Internal Medicine (CDIM) as of December 2022. Use of EPAs in IM core clerkships, including use for grading, types of EPAs, use of supportive measures for assessment, and current validity frameworks. The survey response was 80% (112/140); two additional respondents completed the section on EPA use (n = 114). Approximately half of respondents (47%) reported their IM clerkship used EPAs. Among schools accredited after 1977, a higher percentage was associated with having incorporated EPAs (p = 0.03). The Association of American Medical Colleges Core EPAs for Entering Residency (CEPAER) was the most common framework used by Clerkship Directors (CDs) for developing EPAs (55%). Most CDs (56%) used EPAs for both formative and summative assessments, and approximately half of CDs (48%) used EPAs for a portion of the final grade determination. CDs who used EPAs were no more likely to report efforts to ensure the validity of assessment, the use of faculty development, or that written assessments were a valid measure of students' performance compared to those who did not use EPAs. Although EPAs have experienced substantial uptake in the IM clerkship and contribute to formative and summative assessment of learners, their use does not appear to be associated with enhanced efforts to obtain validity information.

Structures and Processes of Grading Committees in Internal Medicine Clerkships: Results of a National Survey.

Clerkship grades are important in the residency selection process but can be influenced by individual bias and grading tendencies. Although clinical competency committees are standard in graduate medical education, in undergraduate medical education, they have not gained widespread traction. This study describes structures and processes of grading committees in internal medicine (IM) clerkships and strategies used to mitigate grading bias. From September to December 2022, the Clerkship Directors in Internal Medicine conducted its annual survey of IM core clerkship directors at 140 U.S. and U.S. territory-based medical schools. This study was based on 23 questions about grading committees in IM clerkships. The survey response rate was 80% (n = 112/140). Forty-seven respondents (42%) reported using grading committees in their IM clerkship (median committee size, 7; range, 3-20) (primarily clerkship leadership and faculty). Responsibilities included determining grades for all students (31 [66%]) and students at borderline of failing (30 [64%]), adjudicating on students with professionalism concerns (25 [53%]), and reconciling discordant clinical evaluations (24 [51%]). To mitigate deliberation bias, committees most frequently used multisource assessments (38 [81%]) and adoption of a shared mental model (36 [77%]). Approximately one-third of grading committees "rarely" discussed gender (14 [30%]) and race or ethnicity (15 [32%]), and 7 committees (15%) "never" discussed gender and race or ethnicity. Clerkship directors perceived developing a shared mental model (60 [92%]), promoting consistency (59 [91%]) and transparency (57 [88%]) in the process, mitigating assessment bias (58 [89%]), improving student satisfaction (54 [83%]), and sharing grading responsibility (44 [68%]) as potential benefits. This study found that grading committees in IM clerkships are not widely used and that existing committees vary in structure and process. These findings highlight an opportunity for medical schools to consider using grading committees to improve grade assignment and address grading inconsistencies.

Bias Reporting in the Clinical Learning Environment: A National Survey of Internal Medicine Clerkship Directors.

Bias exists in the internal medicine (IM) clinical learning environment; however, it is unclear how often bias is identified by clerkship directors (CDs), how bias is addressed, and whether best practices exist for identifying or mitigating bias. This study investigated how IM CDs receive and respond to bias reports in the clinical learning environment. In May 2021, the Clerkship Directors in Internal Medicine (CDIM) created an 18-question survey assessing the frequency of bias reports, macroaggressions and microaggressions, and report outcomes. Of the 152 U.S. medical schools that met study accreditation criteria, the final survey population included 137 CDs (90%) whose medical schools held valid CDIM membership. Of the 137 surveys sent, 100 were returned (survey response rate, 73%). Respondents reported a median of 3 bias events (interquartile range, 1-4; range, 0-50) on the IM clerkship in the past year. Among 76 respondents who reported 1 or more event, microaggressions represented 43 of the 75 total events (57%). No mechanism emerged as the most commonly used method for reporting bias. Race/ethnicity (48 of 75 [64%]) and gender (41 of 75 [55%]) were cited most as the basis for bias reports, whereas the most common sources of bias were student interactions with attending physicians (51 of 73 [70%]) and residents (40 of 73 [55%]). Of the 75 respondents, 53 (71%) described the frequency of bias event reports as having increased or remained unchanged during the past year. Only 48 CDs (49%) responded that they were "always" aware of the outcome of bias reports. Bias reports remain heterogeneous, are likely underreported, and lack best practice responses. There is a need to systematically capture bias events to work toward a just culture that fosters accountability and to identify bias events through more robust reporting.

Moving Beyond the Dichotomous Assessment of Professionalism in the Internal Medicine Clerkship: Results of a National Survey of Clerkship Directors.

This study examines how internal medicine clerkship faculty and leadership conceptualize professionalism and professional behaviors and attitudes, identifies whether and how faculty use metrics to assess professionalism and factor it into clerkship grades, and describes barriers that prevent faculty from feeling prepared to support the development of professional behaviors in students. The Clerkship Directors in Internal Medicine opened a call for thematic survey section proposals to its physician-faculty members, blind-reviewed all submissions, and selected 4 based on internal medicine clinical clerkship training experience relevance. The survey launched on October 5 and closed on December 7, 2021. Data were analyzed using descriptive statistics. Of 137 core clerkship directors (CDs) at Liaison Committee on Medical Education-accredited medical schools, 103 (75.2%) responded to the survey. Of 102 respondents (1 nonrespondent), 84 (82.4%) identified professional behavior lapses in involvement and 60 (58.8%) identified introspection lapses. Of 103 respondents, 97 (94.2%) reported that their clerkships ask clinical faculty and residents to formally evaluate professionalism, and 64 (62.1%) reported that they factor professionalism assessments into final clerkship grades. CDs reported multiple barriers to addressing professionalism directly with students, including logistical barriers, professionalism assessment subjectivity concerns, and the possible adverse effect of an unprofessional label for students. Professionalism assessment and remediation in medical education currently center on a deficit model that seeks to identify and remediate professionalism lapses, rather than a developmental model that seeks to nurture growth. This dichotomous characterization of behaviors as professional or unprofessional limits assessment and can adversely affect the learning environment. The authors propose a shift to a developmental model that considers professionalism as a continuous process parallel to the acquisition of clinical skills and medical knowledge.

Reply to comment on “Evaluation of pharmacy residency recruitment and interview processes during the COVID‐19 pandemic”

JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACYVolume 6, Issue 6 p. 655-656 LETTER TO THE EDITOR Reply to comment on “Evaluation of pharmacy residency recruitment and interview processes during the COVID-19 pandemic” Kayla R. Stover Pharm.D., FCCP, Corresponding Author Kayla R. Stover Pharm.D., FCCP [email protected] orcid.org/0000-0002-8635-0137 University of Mississippi School of Pharmacy, Jackson, Mississippi, USA Correspondence Kayla R. Stover, University of Mississippi School of Pharmacy, 2500 North State Street, Jackson, MS 39216, USA. Email: [email protected]Search for more papers by this authorDavid A. Cretella Pharm.D., David A. Cretella Pharm.D. University of Mississippi Medical Center, Jackson, Mississippi, USASearch for more papers by this authorKatie E. Barber Pharm.D., Katie E. Barber Pharm.D. University of Mississippi School of Pharmacy, Jackson, Mississippi, USASearch for more papers by this authorJamie L. Wagner Pharm.D., Jamie L. Wagner Pharm.D. orcid.org/0000-0002-6006-7894 University of Mississippi School of Pharmacy, Jackson, Mississippi, USASearch for more papers by this authorMary Joyce B. Wingler Pharm.D., Mary Joyce B. Wingler Pharm.D. University of Mississippi Medical Center, Jackson, Mississippi, USASearch for more papers by this author Kayla R. Stover Pharm.D., FCCP, Corresponding Author Kayla R. Stover Pharm.D., FCCP [email protected] orcid.org/0000-0002-8635-0137 University of Mississippi School of Pharmacy, Jackson, Mississippi, USA Correspondence Kayla R. Stover, University of Mississippi School of Pharmacy, 2500 North State Street, Jackson, MS 39216, USA. Email: [email protected]Search for more papers by this authorDavid A. Cretella Pharm.D., David A. Cretella Pharm.D. University of Mississippi Medical Center, Jackson, Mississippi, USASearch for more papers by this authorKatie E. Barber Pharm.D., Katie E. Barber Pharm.D. University of Mississippi School of Pharmacy, Jackson, Mississippi, USASearch for more papers by this authorJamie L. Wagner Pharm.D., Jamie L. Wagner Pharm.D. orcid.org/0000-0002-6006-7894 University of Mississippi School of Pharmacy, Jackson, Mississippi, USASearch for more papers by this authorMary Joyce B. Wingler Pharm.D., Mary Joyce B. Wingler Pharm.D. University of Mississippi Medical Center, Jackson, Mississippi, USASearch for more papers by this author First published: 07 June 2023 https://doi.org/10.1002/jac5.1824Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1Kulawiak J, Hovey S, Ohler K. Comment on “Evaluation of pharmacy residency recruitment and interview processes during the COVID-19 pandemic”. J Am Coll Clin Pharm. 2023; 6: 654. 2Wingler MJB, Cretella DA, Wagner JL, Barber KE, Bookstaver PB, Freeman L, et al. Evaluation of pharmacy residency recruitment and interview processes during the COVID-19 pandemic (2020-2021 application cycle). J Am Coll Clin Pharm. 2023; 6(3): 241– 51. https://doi.org/10.1002/jac5.1684 3Beechinor RJ, Eche IM, Edmonds N, Mordino J, Serafin H, Roller L, et al. Perceptions of a virtual interview process for pharmacy residents during the COVID-19 pandemic: a multisite survey of residency candidates, preceptors, and residency program directors. Am J Health Syst Pharm. 2022; 79(16): 1385– 92. https://doi.org/10.1093/ajhp/zxac130 4Hovey SW, Arif SA, Khan AM, Hyderi AF, Varughese C, Peksa GD, et al. More than a buzz word: building diversity, equity, and inclusion into pharmacy residency recruitment. J Am Coll Clin Pharm. 2023; 6: 154– 64. https://doi.org/10.1002/jac.5.1716 5Grace AJ, Teigen K, Buck K, Clark MS, Seavey A, Brennan J, et al. Evaluating changes in family medicine applicant characteristics following the onset of virtual interviewing. Fam Med. 2022; 54(10): 791– 7. https://doi.org/10.22454/FamMed.2022.625652 6Alexandraki I, Ismail N, Lai CJ, Duca NS, Ratcliffe T, Kisielewski M, et al. Medical student advising during virtual residency recruitment: results of a national survey of internal medicine clerkship and sub-internship directors. Med Educ Online. 2023; 28(1):2143926. https://doi.org/10.1080/10872981.2022.2143926 7Carmody JB, Rosman IS, Carlson JC. Application fever: reviewing the causes, costs, and cures for residency application inflation. Cureus. 2021; 13(3):e13804. https://doi.org/10.7759/cureus.13804 8Stewart DW, Neumeister JR. What we learned in the pandemic about graduate teaching. The Chronicle of Higher Education. 2021 Available from: https://www.chronicle.com/article/what-we-learned-in-the-pandemic-about-graduate-training 9 ASHP Match Statistics. ASHP Match. 2023 Available from: https://natmatch.com/ashprmp/stats.html Volume6, Issue6June 2023Pages 655-656 ReferencesRelatedInformation

Reviewing Internal Medicine Clerkship Grading Through a Proequity Lens: Results of a National Survey.

Equity in assessment and grading has become imperative across medical education. Although strategies to promote equity exist, there may be variable penetrance across institutions. The objectives of this study were to identify strategies internal medicine (IM) clerkship directors (CDs) use to reduce inequities in assessment and grading and explore IM CDs' perceptions of factors that impede or facilitate the implementation of these strategies. From October to December 2021, the Clerkship Directors in Internal Medicine of the Alliance for Academic Internal Medicine conducted its annual survey of IM core CDs at 137 U.S. and U.S. territory-based medical schools. This study is based on 23 questions from the survey about equity in IM clerkship assessment and grading. The survey response rate was 73.0% (100 of 137 medical school CDs). Use of recommended evidence-based strategies to promote equity in clerkship assessment and grading varied among IM clerkships. Only 30 respondents (30.0%) reported that their clerkships had incorporated faculty development on implicit bias for clinical supervisors of students; 31 (31.0%) provided education to faculty on how to write narrative assessments that minimize bias. Forty respondents (40.0%) provided guidance to clerkship graders on how to minimize bias when writing final IM clerkship summaries, and 41 (41.0%) used grading committees to determine IM clerkship grades. Twenty-three CDs (23.0%) received formal education by their institution on how to generate clerkship grades and summaries in a way that minimized bias. This national survey found variability among medical schools in the application of evidence-based strategies to promote equity in assessment and grading within their IM clerkships. Opportunities exist to adopt and optimize proequity grading strategies, including development of programs that address bias in clerkship assessment and grading, reevaluation of the weight of standardized knowledge exam scores on grades, and implementation of grading committees.

Medical student advising during virtual residency recruitment: results of a national survey of internal medicine clerkship and sub-internship directors

ABSTRACT Introduction The residency application process is a critical time for medical students. The COVID-19 pandemic prompted changes to the residency recruitment procedures with the conversion of interviews to a virtual format. For medical school advisors guiding students on an all-virtual residency application process brought uncertainty to their advising practices. Thus, this study aimed to identify advising practices during the 2021 virtual application cycle. Methods We administered an IRB-exempt national survey through the Clerkship Directors in Internal Medicine to 186 internal medicine core/co-/associate/assistant clerkship directors and sub-internship directors representing 140 Liaison Committee on Medical Education-accredited U.S./U.S.-territory-based medical schools in spring 2021. The 23-question survey was designed and pilot-tested by faculty-educators and leaders with expertise in undergraduate medical education. Data analysis included paired t- and z-tests and thematic analysis of open-ended questions. Results The institutional response rate was 67% (93/140) and individual rate 55% (103/186). Half of the respondents felt prepared/very prepared (40% and 13% respectively) for their advising roles. Compared to pre-pandemic cycles, respondents advised a typical student in the middle-third of their class at their institution to apply to more residency programs (mean 24 programs vs 20, p < 0.001) and accept more interviews (mean 14 interviews vs 12, p < 0.001). Sixty-three percent (64/101) of respondents spent more time on student advising; 51% (51/101) reported more students asked them for informal advice. Fifty-nine percent (60/101) of respondents reported their advisees were able to assess a residency program ‘somewhat well;’ 31% (31/101) expressed that residency recruitment should remain entirely virtual in the future. Conclusion The transition to virtual residency recruitment due to COVID-19 prompted advising practices that may have contributed to application inflation and increased advising workload. Future studies should explore longitudinal outcomes of virtual interviews on student success to guide best practices in how to advise students during residency recruitment.

Teaching Telemedicine in the COVID-19 Era: a National Survey of Internal Medicine Clerkship Directors.

BackgroundPrior to the COVID-19 pandemic, telemedicine (TM) experiences in undergraduate medical education were uncommon. When students’ clinical experiences were interrupted due to the pandemic, TM education provided opportunities for students to participate in clinical care while adhering to social distancing guidelines.ObjectiveTo assess the prevalence of TM experiences in the internal medicine (IM) core clerkship experience prior to the COVID-19 pandemic, during interruption in clinical clerkships, and following the return to in-person activities at US medical schools.DesignThe Clerkship Directors in Internal Medicine (CDIM) survey is a national, annually recurring thematic survey of IM core clerkship directors. The 2020 survey focused on effects of the COVID-19 pandemic, including a section about TM. The survey was fielded online from August through October 2020.ParticipantsA total of 137 core clinical medicine clerkship directors at Liaison Committee on Medical Education fully accredited US/US territory–based medical schools.Main MeasuresA 10-item thematic survey section assessing student participation in TM and assessment of TM-related competencies.Key ResultsThe response rate was 73.7% (101/137 medical schools). No respondents reported TM curricular experiences prior to the pandemic. During clinical interruption, 39.3% of respondents reported TM experiences in the IM clerkship, whereas 24.7% reported such experiences occurring at the time they completed the survey. A higher percentage of clerkships with an ambulatory component reported TM to be an important competency compared to those without an ambulatory component.ConclusionsThe extent to which TM was used in the IM clinical clerkship, and across clinical clerkships, increased substantially when medical students were removed from in-person clinical duties as a response to COVID-19. When students returned to in-person clinical duties, experiences in TM continued, suggesting the continued value of TM as part of the formal education of students during the medicine clerkship. Curricula and faculty development will be needed to support TM education.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07061-4.

Supplementing the Subinternship: Effect of E-Learning Modules on Subintern Knowledge and Confidence

Supplementing the Subinternship: Effect of E-Learning Modules on Subintern Knowledge and Confidence

In Reply to Kurtz et al.

We appreciate Kurtz and colleagues’ thoughtful comments encouraging further discussion about the impact of our study. We would like to address 3 main elements from their letter. First, Kurtz and colleagues appropriately question whether test-taking ability or test familiarity may explain NBME medicine subject exam performance. Because United States Medical Licensing Examination Step 1 performance only explains 46% of the variance, the question remains as to what other factors may be associated with medicine subject exam scores. We stated in our Research Report that the NBME medicine subject exam most likely represents “overall medical knowledge” because it has a wider breadth of content than that addressed in internal medicine clerkship curricula or patient conditions than a student would see during this clerkship. We agree with Kurtz and colleagues that other factors may play an important role. We also agree the results of our study do not capture important details about the potential impact of Step 1 timing on future medicine subject exam performance. At most schools, students still take Step 1 before the core clerkships (we stated as such in our Research Report). Moreover, the question remains if the timing of Step 1 represents consolidation of knowledge or perhaps increased focus on test-taking strategies and familiarity with test questions. Clerkship exams also require students to balance studying for the exam with clinical duties, and higher performance may reflect better ability to manage these dual responsibilities. Lastly, Kurtz and colleagues correctly identify that our study is not an endorsement of the NBME subject exam. Rather, it is an exploration of what factors may be associated with NBME medicine subject exam performance among so many different internal medicine structures and experiences. Because many internal medicine clerkship directors use the exam as a barometer for their students compared with national data, clerkship directors may be reassured that their students are not necessarily disadvantaged (or advantaged) based on these differences. At the same time, the internal medicine educational community may want to ask the larger question: What are we are actually measuring if students’ scores are not impacted by more and varied clinical experiences? Our results suggest that the exam is measuring medical knowledge largely distinct from that acquired through clinical learning experiences.

Internal Medicine Student Education on Direct-Care Hospital Medicine Services: Results of a National Survey

Traditionally, internal medicine (IM) inpatient student rotations at clinical sites include teams of students, residents, and an attending physician. With the exponential growth since its relatively recent introduction, hospital medicine has had an expanding and enduring presence in academic medicine. In 2010, the Clerkship Directors in Internal Medicine (CDIM) Annual Survey found 91.0% of responding programs had students learning under the guidance of hospital medicine physicians.1 Hospital medicine attendings make up a growing portion of IM inpatient teaching faculty and are perceived by trainees as more effective general medicine ward teachers than other medicine or traditional subspecialist attendings.

Capsule Commentary on Glod et al., Clerkship Roles and Responsibilities in a Rapidly Changing Landscape: a National Survey of Internal Medicine Clerkship Directors.

Capsule Commentary on Glod et al., Clerkship Roles and Responsibilities in a Rapidly Changing Landscape: a National Survey of Internal Medicine Clerkship Directors.

Clerkship Roles and Responsibilities in a Rapidly Changing Landscape: a National Survey of Internal Medicine Clerkship Directors.

In the rapidly changing landscape of undergraduate medical education (UME), the roles and responsibilities of clerkship directors (CDs) are not clear. To describe the current roles and responsibilities of Internal Medicine CDs. National annual Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. One hundred twenty-nine clerkship directors at all Liaison Committee on Medical Education accredited US medical schools with CDIM membership as of September 1, 2017. Responsibilities of core CDs, including oversight of other faculty, and resources available to CDs including financial support and dedicated time. The survey response rate was 83% (107/129). Ninety-four percent of the respondents oversaw the core clerkship inpatient experience, while 47.7% (n = 51) and 5.6% (n = 6) oversaw the outpatient and longitudinal integrated clerkships respectively. In addition to oversight, CDs were responsible for curriculum development, evaluation and grades, remediation, scheduling, student mentoring, and faculty development. Less than one-third of CDs (n = 33) received the recommended 0.5 full-time equivalent (FTE) support for their roles, and 15% (n = 16) had less than 20% FTE support. An average 0.41 FTE (SD .2) was spent in clinical work and 0.20 FTE (SD .21) in administrative duties. Eighty-three percent worked with other faculty who assisted in the oversight of departmental UME experiences, with FTE support varying by role and institution. Thirty-five percent of CDs (n = 38) had a dedicated budget for managing their clerkship. The responsibilities of CDs have increased in both number and complexity since the dissemination of previous guidelines for expectations of and for CDs in 2003. However, resources available to them have not substantially changed.

Exploring Perspectives from Internal Medicine Clerkship Directors in the USA on Effective Narrative Evaluation: Results from the CDIM National Survey.

Clinical performance evaluations play a critical role in determining medical school clerkship grades. This study aimed to provide clarification from clerkship directors in internal medicine on what constitutes an effective and informative narrative description of student performance. In September 2016, the Clerkship Directors in Internal Medicine (CDIM) electronically administered its annual, voluntary, and confidential cross-sectional survey of its US membership. One section of the survey asked six questions regarding the helpful components of an effective narrative evaluation. Respondents were asked to rate the effectiveness of elements contained within narrative evaluations of students. Ninety-five CDIM members responded to the survey with an overall response rate of 74.2%. Descriptions of skills and behaviors were felt to be the most important, followed by a description of the overall synthetic or global assessment level of the student. Descriptions of personality and attitude were the next highest rated feature followed by adjectives describing performance. Length was felt to be the least important component. In free-text comments, several respondents indicated that direct observation of performance and specific examples of skills and behaviors are also desirable. Narrative evaluations of students that explicitly comment on skills, behaviors, and an overarching performance level of the learner are strongly preferred by clerkship directors. Direct observation of clinical performance and giving specific examples of such behaviors give evaluations even more importance. Faculty development on evaluation and assessment should include instruction on these narrative assessment characteristics.

Teaching Safe Opioid Prescribing During the Opioid Epidemic: Results of the 2018 Clerkship Directors in Internal Medicine Survey.

Educating medical trainees across the continuum is essential to a multifaceted strategy for addressing the opioid epidemic. To assess the current state of internal medicine clerkship content on safe opioid prescribing and opioid use disorder, and barriers to curriculum implementation. National Annual (2018) Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. One hundred thirty-four clerkship directors at all Liaison Committee of Medical Education accredited US medical schools with CDIM membership as of October 1, 2018. The survey section on safe opioid prescribing and opioid use disorder education in the internal medicine clerkship addressed assessment of current curricula, perceived importance of curricula, barriers to implementation, and plans to start or expand curricula. Descriptive statistics were used to summarize responses, and Pearson's chi-square and Fisher's exact tests for statistical comparisons. The survey response rate was 82% (110/134). Overall 54.1% of responding institutions reported covering one or more topics related to safe opioid prescribing or opioid use disorder in the internal medicine clerkship. A preponderance of clerkship directors (range 51-86%) reported that various opioid-related topics were important to cover in the internal medicine clerkship. Safe opioid prescribing topics were covered more frequently than topics related specifically to opioid use disorder. The main barriers identified included time (80.9%) and lack of faculty expertise (65.5%). Clerkship directors agreed that incorporating safe opioid prescribing and opioid use disorder topics in the internal medicine clerkship is important, despite wide variation in current curricula. Addressing curricular time constraints and lack of faculty expertise in internal medicine clerkships will be key to successfully integrating content to address the opioid epidemic.

A National Survey of Undergraduate Clinical Education in Internal Medicine.

In the present milieu of rapid innovation in undergraduate medical education at US medical schools, the current structure and composition of clinical education in Internal Medicine (IM) is not clear. To describe the current composition of undergraduate clinical education structure in IM. National annual Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. One hundred twenty-nine clerkship directors at all Liaison Committee on Medical Education accredited US medical schools with CDIM membership as of September 1, 2017. IM core clerkship and post-core clerkship structure descriptions, including duration, educational models, inpatient experiences, ambulatory experiences, and requirements. The survey response rate was 83% (107/129). The majority of schools utilized one core IM clerkship model (67%) and continued to use a traditional block model for a majority of their students (84%). Overall 26% employed a Longitudinal Integrated Clerkship model and 14% employed a shared block model for some students. The mean inpatient duration was 7.0 ± 1.7weeks (range 3-11weeks) and 94% of clerkships stipulated that students spend some inpatient time on general medicine. IM-specific ambulatory experiences were not required for students in 65% of IM core clerkship models. Overall 75% of schools did not require an advanced IM clinical experience after the core clerkship; however, 66% of schools reported a high percentage of students (> 40%) electing to take an IM sub-internship. About half of schools (48%) did not require overnight call or night float during the clinical IM sub-internship. Although there are diverse core IM clerkship models, the majority of IM core clerkships are still traditional block models. The mean inpatient duration is 7weeks and 65% of IM core clerkship models did not require IM-specific ambulatory education.

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).

Current and Optimal Training in High-Value Care in the Internal Medicine Clerkship: A National Curricular Needs Assessment

The clinical skills needed to practice high-value care (HVC) are core to all medical disciplines. Medical students form practice habits early, and HVC instruction is essential to this formation. The purpose of this study was to describe the state of HVC instruction and assessment in internal medicine clerkships and identify needs for additional curricula. In 2014, the Clerkship Directors in Internal Medicine conducted its annual survey of 121 U.S. and Canadian medical schools. The authors evaluated a subset of questions from that survey asking clerkship directors about the perceived importance of HVC instruction, type and amount of formal instruction and assessment, achievement of student competence, prioritization of topics, and barriers to curriculum implementation. Descriptive statistics were used to summarize responses, and chi-square tests were used to examine associations between response categories. The overall response rate was 77.7% (94/121). The majority (85; 91.4%) agreed that medical schools have a responsibility to teach about HVC across all phases of the curriculum. Of respondents, 31 (32.9%) reported their curricula as having some formal instruction on HVC, and 66 (70.2%) felt the amount was inadequate. Highest-priority topics for inclusion included overuse of diagnostic tests and treatments, defining value and its application to clinical reasoning, and balancing benefit and harm. Only 11 (17.8%) assessed students' competence in HVC. Internal medicine clerkship directors reported that HVC is insufficiently taught and assessed in medical school, despite relevance to practice. Developing generalizable curricular materials, faculty development, and dedicated curricular time may enhance HVC education.

Enterprise Microblogging to Augment the Subinternship Clinical Learning Experience: A Proof-of-Concept Quality Improvement Study.

BackgroundAlthough the Clerkship Directors in Internal Medicine (CDIM) has created a core subinternship curriculum, the traditional experiential subinternship may not expose students to all topics. Furthermore, academic institutions often use multiple clinical training sites for the student clerkship experience.ObjectiveThe objective of this study was to sustain a Web-based learning community across geographically disparate sites via enterprise microblogging to increase subintern exposure to the CDIM curriculum.MethodsInternal medicine subinterns used Yammer, a Health Insurance Portability and Accountability Act (HIPAA)–secure enterprise microblogging platform, to post questions, images, and index conversations for searching. The subinterns were asked to submit 4 posts and participate in 4 discussions during their rotation. Faculty reinforced key points, answered questions, and monitored HIPAA compliance.ResultsIn total, 56 medical students rotated on an internal medicine subinternship from July 2014 to June 2016. Of them, 84% returned the postrotation survey. Over the first 3 months, 100% of CDIM curriculum topics were covered. Compared with the pilot year, the scale-up year demonstrated a significant increase in the number of students with >10 posts (scale-up year 49% vs pilot year 19%; P=.03) and perceived educational experience (58% scale-up year vs 14% pilot year; P=.006). Few students (6%) noted privacy concerns, but fewer students in the scale-up year found Yammer to be a safe learning environment.ConclusionsSupplementing the subinternship clinical experience with an enterprise microblogging platform increased subinternship exposure to required curricular topics and was well received. Future work should address concerns about safe learning environment.

Diffusion of innovation and longitudinal integrated clerkships: Results of the clerkship directors in internal medicine annual survey

Purpose: Longitudinal integrated clerkships (LICs) are innovative educational models that emphasize medical student continuity with patients, preceptors, peers, and health systems. We characterize LIC growth in the US and interpret the growth using Rogers’ Diffusion of Innovation Theory.Methods: In 2015, we surveyed 123 US allopathic medical schools affiliated with Clerkship Directors in Internal Medicine (CDIM). The organization’s annual survey was supplemented with questions aimed to quantify the number of current and planned LICs and to determine the intended purpose of starting LICs.Results: Of the 94 (out of 123 possible) schools which were responding, 35 (37%) have at least one LIC of six months or greater; of these 20 are year-long. Nineteen schools are engaged in planning a new LIC or increasing the number of students in an LIC. At least 45 (48%) responding schools will have LICs in future years. Respondents report implementing LICs to foster continuity of care, support patient-centeredness, advance inter-professional education, and address workforce shortages.Conclusions: The number of LICs is increasing across the US. We considered the data through the lens of Diffusion of Innovation Theory, speculated that LIC growth has reached “critical mass,” and considered why the LIC innovation may be self-sustaining.