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

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


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