Advertisement

The Importance of Adding Discernment to the Acting Internship – A Necessary Shift in Culture Towards Competency-Based Metrics

  • Adam M. Garber
    Correspondence
    Corresponding author: Adam M. Garber, Virginia Commonwealth University, Department of Internal Medicine, 1200 East Broad Street, PO Box 980102, Richmond, VA, 23298-0102
    Affiliations
    Associate Professor of Medicine, School of Medicine and Internal Medicine Acting Internship Director, Virginia Commonwealth University School of Medicine, Richmond, VA
    Search for articles by this author
  • Allison H. Ferris
    Affiliations
    Associate Professor of Medicine, Program Director, Internal Medicine Residency Program, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
    Search for articles by this author
  • T. Robert Vu
    Affiliations
    Associate Professor of Clinical Medicine, Internal Medicine Acting Internship Director, Indiana University School of Medicine, Indianapolis, IN
    Search for articles by this author

      Highlights

      • The acting internship (AI) rotation is widely viewed as one of the most important clinical experiences of medical school, however it has several limitations.
      • AI rotation limitations include, but are not limited to, a high prevalence of grade inflation and lack of standardization between institutions regarding rotation structure, curriculum, and grading structure.
      • We highlight several recommendations to mitigate current limitations, including developing national consensus-based AI curricula and competency assessments, and use of department chair's standardized letters of evaluation to improve transparency of AI rotation clinical and grading structure.
      • Additionally, establishing funding for AI directors to facilitate changes is a must to help elevate the importance and potential of the AI rotation in fostering advanced clinical skills in preparation for intern year.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pereira AG
        • Harrell HE
        • Weissman A
        • Smith CD
        • Dupras D
        • Kane GC.
        Important Skills for Internship and the Fourth-Year Medical School Courses to Acquire Them: A National Survey of Internal Medicine Residents.
        AcadMed. 2016; 91: 821-826https://doi.org/10.1097/ACM.0000000000001134
        • Ryan MS
        • Lockeman KS
        • Feldman M
        • Dow A.
        The Gap Between Current and Ideal Approaches to the Core EPAs: A Mixed Methods Study of Recent Medical School Graduates.
        MedSciEduc. 2016; 26 (Journal Article): 463
        • Anderson IJ
        • Berk J
        • Bertram A
        • et al.
        Supplementing the Subinternship: Effect of E-Learning Modules on Subintern Knowledge and Confidence.
        Am J Med. 2021; 134 (e13): 1052-1057https://doi.org/10.1016/j.amjmed.2021.04.012
        • Cacamese SM
        • Elnicki M
        • Speer AJ.
        Grade Inflation and the Internal Medicine Subinternship: A National Survey of Clerkship Directors.
        Teach Learn Med. 2007; 19: 343-346https://doi.org/10.1080/10401330701542529
        • Grover S
        • Swisher-McClure S
        • Sosnowicz S
        • et al.
        Grade Inflation in Medical Student Radiation Oncology Clerkships: Missed Opportunities for Feedback?.
        International Journal of Radiation Oncology*Biology*Physics. 2015; 92: 740-744https://doi.org/10.1016/j.ijrobp.2015.03.039
        • Johnson J
        • Patel N
        • Wang P
        • Mulcahey M.
        Grading Medical Students During their Fourth Year ... | MedEdPublish. July 20, 2017; (Published onlineAccessed January 4, 2022)
        • Westerman ME
        • Boe C
        • Bole R
        • et al.
        Evaluation of Medical School Grading Variability in the United States: Are All Honors the Same?.
        Acad Med. 2019; 94: 1939-1945https://doi.org/10.1097/ACM.0000000000002843
        • Pincavage AT
        • Fagan MJ
        • Osman NY
        • et al.
        A National Survey of Undergraduate Clinical Education in Internal Medicine.
        J Gen Intern Med. 2019; 34: 699-704https://doi.org/10.1007/s11606-019-04892-0
        • National Resident Matching Program
        Data Release and Research Committee: Results of the 2018 NRMP Program Director Survey.
        National Resident Matching Program, 2018 (Accessed January 4, 2022)
        • National Resident Matching Program
        Data Release and Research Committee: Results of the 2021 NRMP Program Director Survey.
        National Resident Matching Program, 2021 (Accessed October 21, 2021)
        • Schiller JH
        • Burrows HL
        • Fleming AE
        • Keeley MG
        • Wozniak L
        • Santen SA.
        Responsible Milestone-Based Educational Handover With Individualized Learning Plan From Undergraduate to Graduate Pediatric Medical Education.
        AcadPediatr. 2017; (Journal Article)
        • Wancata LM
        • Morgan H
        • Sandhu G
        • Santen S
        • Hughes DT.
        Using the ACMGE Milestones as a Handover Tool From Medical School to Surgery Residency.
        JSurgEduc. 2017; 74: 519-529
        • Morgan HK
        • Schiller J
        • Santen S
        • et al.
        Program Directors’ Perceptions of a Post-Match Competency Handover Between Medical School and Residency.
        MedSciEduc. 2018; 28: 375-380https://doi.org/10.1007/s40670-018-0560-3
        • Sozener CB
        • Lypson ML
        • House JB
        • et al.
        Reporting Achievement of Medical Student Milestones to Residency Program Directors: An Educational Handover.
        AcadMed. 2016; 91: 676-684https://doi.org/10.1097/ACM.0000000000000953
        • Garber AM
        • Ryan MS
        • Santen SA
        • Goldberg SR.
        Redefining the Acting Internship in the Era of Entrustment: One Institution's Approach to Reforming the Acting Internship.
        MedSciEduc. February 6, 2019; (Published online)https://doi.org/10.1007/s40670-019-00692-7
        • Englander R
        • Flynn T
        • Call S
        • et al.
        Toward Defining the Foundation of the MD Degree: Core Entrustable Professional Activities for Entering Residency.
        AcadMed. 2016; 91: 1352-1358https://doi.org/10.1097/ACM.0000000000001204
        • Vu TR
        • Angus SV
        • Aronowitz PB
        • et al.
        The Internal Medicine Subinternship–Now More Important than Ever: A Joint CDIM-APDIM Position Paper.
        JGenInternMed. 2015; 30: 1369-1375https://doi.org/10.1007/s11606-015-3261-2
        • Duca NS
        • Lai CJ
        • Ratcliffe TA
        • et al.
        Roles and Responsibilities of Medicine Subinternship Directors : Medicine Subinternship Director Roles.
        J Gen Intern Med. September 20, 2021; (Published online)https://doi.org/10.1007/s11606-021-07128-2
        • Elnicki DM
        • Gallagher S
        • Willett L
        • et al.
        Course Offerings in the Fourth Year of Medical School: How U.S. Medical Schools Are Preparing Students for Internship.
        AcadMed. 2015; 90: 1324-1330https://doi.org/10.1097/ACM.0000000000000796
        • King CJ
        • Bolton A
        • Guerrasio J
        • Trosterman A.
        Defining Medical Student Patient Care Responsibilities Before Intern Year: Results of a National Survey.
        South Med J. 2017; 110: 765-769https://doi.org/10.14423/SMJ.0000000000000738
        • Wallach PM
        • Foster LM
        • Cuddy MM
        • Hammoud MM
        • Holtzman KZ
        • Swanson DB.
        Electronic Health Record Use in Internal Medicine Clerkships and Sub-internships for Medical Students Graduating from 2012 to 2016.
        J Gen Intern Med. 2019; 34: 705-711https://doi.org/10.1007/s11606-019-04902-1
        • Andrews JS
        • Bale JFJ
        • Soep JB
        • et al.
        Education in Pediatrics Across the Continuum (EPAC): First Steps Toward Realizing the Dream of Competency-Based Education.
        Academic Medicine. 2018; 93: 414-420https://doi.org/10.1097/ACM.0000000000002020
        • Vu TR
        • Ferris AH
        • Sweet ML
        • et al.
        The New Internal Medicine Subinternship Curriculum Guide: a Report from the Alliance for Academic Internal Medicine.
        J Gen Intern Med. 2019; 34: 1342-1347https://doi.org/10.1007/s11606-019-04957-0
        • Love JN
        • Deiorio NM
        • Ronan-Bentle S
        • et al.
        Characterization of the Council of Emergency Medicine Residency Directors’ standardized letter of recommendation in 2011-2012.
        Acad Emerg Med. 2013; 20: 926-932https://doi.org/10.1111/acem.12214
        • Martin DR
        • McNamara R.
        The CORD Standardized Letter of Evaluation: Have We Achieved Perfection or Just a Better Understanding of Our Limitations?.
        J Grad Med Educ. 2014; 6: 353-354https://doi.org/10.4300/JGME-D-14-00172.1
        • Lang VJ
        • Aboff BM
        • Bordley DR
        • et al.
        Guidelines for Writing Department of Medicine Summary Letters.
        The American Journal of Medicine. 2013; 126: 458-463https://doi.org/10.1016/j.amjmed.2013.01.018
        • AAIM Guidelines for Internal Medicine Structured Evaluative Letter
        Alliance for Academic Internal Medicine. January 10, 2022; (Accessed)
        • Murray KE
        • Lane JL
        • Carraccio C
        • et al.
        Crossing the Gap: Using Competency-Based Assessment to Determine Whether Learners Are Ready for the Undergraduate-to-Graduate Transition.
        Acad Med. 2019; 94: 338-345https://doi.org/10.1097/ACM.0000000000002535