A National Survey of Undergraduate Clinical Education in Internal Medicine

Abstract

BACKGROUND: 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. OBJECTIVE: To describe the current composition of undergraduate clinical education structure in IM. DESIGN: National annual Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. PARTICIPANTS: 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. MAIN MEASURES: IM core clerkship and post-core clerkship structure descriptions, including duration, educational models, inpatient experiences, ambulatory experiences, and requirements. KEY RESULTS: 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 ± 1.7 weeks (range 3-11 weeks) and 94% of clerkships stipulated that students spend some inpatient time on general medicine. IMspecific 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. CONCLUSIONS: Although there are diverse core IM clerkship models, the majority of IM core clerkships are still traditional block models. The mean inpatient duration is 7 weeks and 65% of IM core clerkship models did not require IM-specific ambulatory education.

Exploring the Intersections of Education and Healthcare Delivery Using a Clinical Learning Environment Framework

“…Pincavage and colleagues examined the current structure of internal medicine clerkships via a national survey of clerkship directors. 10 The results revealed that over half of internal medicine clerkships do not require ambulatory training components. This raises important questions about the alignment, or lack thereof, of the clinical learning environments of medical student internal medicine clerkship education (inpatient predominant) and the likely skills and experiences needed to effectively deliver care in current and future complex health delivery systems.…”

Tackling Some Wicked Problems in Medical Education

“…In the paper entitled BUse of Simulated Patient Encounters to Teach Residents to Respond to Patients who Discriminate Against Health Care Workers,^Eisenberg and Kieffer provide education to firstyear internal medicine residents to improve skills in responding to an unfortunate growing trend, i.e., patients who exhibit discriminatory behavior towards members of the health care team. 4 The residents participated in a BResponding to Bias^workshop. After an instruction to frame an approach to respond, residents experienced four clinical scenarios with standardized patients covering gender bias, class bias, and racial bias.…”

“…Interprofessional educators may be important facilitators of participatory and experiential learning experiences in appropriate settings. [3][4][5][6] Published online April 16, 2019…”

Time for Clinic: Fourth-Year Primary Care Exposure and Clinic Preparedness Among Internal Medicine Interns

“…6 In 2017, clerkship directors reported that time in GIM clinic ranged from 15 half days in the traditional block model to 31 half days as part of longitudinal integrated clerkships. 8 Despite increased attention to outpatient training in medical school, one IM residency program reported that only 15% of interns from a diversity of medical schools felt they received sufficient training in medical school to prepare them for their continuity clinic. 9 One possible reason for the discrepancy between increased medical school primary care curricula and discomfort with primary care among entering IM residents may be that existing training may be insufficient.…”