An Entrustable Professional Activity (EPA)-Based Framework to Prepare Fourth-Year Medical Students for Internal Medicine Careers

Abstract

The purpose of the fourth year of medical school remains controversial. Competing demands during this transitional phase cause confusion for students and educators. In 2014, the Association of American Medical Colleges (AAMC) released 13 Core Entrustable Professional Activities for Entering Residency (CEPAERs). A committee comprising members of the Clerkship Directors in Internal Medicine and the Association of Program Directors in Internal Medicine applied these principles to preparing students for internal medicine residencies. The authors propose a curricular framework based on five CEPAERs that were felt to be most relevant to residency preparation, informed by prior stakeholder surveys. The critical areas outlined include entering orders, forming and answering clinical questions, conducting patient care handovers, collaborating interprofessionally, and recognizing patients requiring urgent care and initiating that care. For each CEPAER, the authors offer suggestions about instruction and assessment of competency. The fourth year of medical school can be rewarding for students, while adequately preparing them to begin residency, by addressing important elements defined in the core entrustable activities. Thus prepared, new residents can function safely and competently in supervised postgraduate settings.

The New Internal Medicine Subinternship Curriculum Guide: a Report from the Alliance for Academic Internal Medicine

“…[4][5][6][7] These gaps have prompted medical educators to focus on the fourth year of medical school as an opportunity to strengthen students' preparedness for internship. 2,[8][9][10][11][12] Among the wide array of fourth-year courses, the subinternship, or acting internship, is commonly viewed by faculty 2,12 and residents 13 as one of the most important clinical experiences in helping senior students prepare for internship.…”

“…19 Soon thereafter, the Alliance for Academic Internal Medicine (AAIM) formed a joint CDIM-APDIM committee to examine the fourth year of medical school with the aim of developing evidence-based recommendations to help students optimize their preparation for internship. [10][11][12][13]20 The Association of American Medical Colleges (AAMC) also established 13 core entrustable professional activities (EPAs) for entering residency, defining a set of foundational skills and behaviors expected of all medical school graduates (Table 1). 21,22 The core EPAs were created as a practical approach to assess the Accreditation Council for Graduate Medical Education (ACGME) six core competencies in workplace settings.…”

Developing an Internship Preparedness Program for Final Year Medical Students

“…Medical schools have an important role in supporting this important transition. Many medical schools and universities are reforming curriculum and providing enhanced training and learning (Aretz, 2003;Elnicki et al, 2017;Heidemann et al, 2018;Stewart et al, 2018). The medical curriculum ensures that medical students amass vast clinical knowledge with a solid grounding in medical science.…”

“…The importance of non-medical skills in facilitating successful transition to internship, work readiness and professional competence is well-recognised (Epstein and Hundert, 2002;Caballero et al, 2011;Scicluna et al, 2014;Drummond et al, 2016;Elnicki et al, 2017). Furthermore, the transition to practice challenge is not unique to medicine, also occurring, for example, in pharmacy (Fejzic and Barker, 2015), dentistry (Dawson et al, 2016), and among veterinarians (Cake et al, 2016).…”

Medical Education Then and Now

“…In this issue of JGIM, Elnicki et al 3 propose a new curricular framework based on five core Entrustable Professional Activities (EPAs) that they argue are most relevant for senior medical students to prepare them to enter internal medicine residencies. Some of these EPAs are specific and pragmatic (e.g., how to enter orders and prescriptions) while others focus on broader skills (e.g., how to collaborate as a member of an inter-professional team).…”