Education First: Reforming the First-Year Curriculum of the Internal Medicine Residency

Abstract

Many opinion leaders of the academic internal medicine community have expressed concern about the adequacy of internal medicine (IM) residency training to prepare residents for their careers and to attract medical students to IM residency programs. In response to those concerns, several core organizations have prepared reports and issued significant recommendations suggesting comprehensive reform and restructuring of IM training programs.The authors discuss their approach, strategy, and efforts to restructure the first year in the IM residency training program at the University of California, Irvine. They point out that educators have often viewed the internship as a rite of passage, heavy with inpatient service commitment. However, in the authors' view, the current trend to residents' early subspecialty commitment has made it imperative that the first year of IM residency be more focused, standardized, meaningful, and effective in order to achieve core educational goals before each resident's career focus has become too narrowed and while the big picture is more apparent. The authors describe in detail their review of their first-year curriculum based on consensus goals and objectives. This process led to a restructuring of the first year that places emphasis on a defined educational model and a central core curriculum. The authors conclude that residency program leaders can restructure the first year to provide a model of education that includes appropriate educational experiences as well as meaningful time for reflection and professional growth.

Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations

“…19 In addition, although prior studies have measured multitasking as the co-occurrence of any activity, 4 we measure and provide more targeted definitions of multitasking. Without a consensus definition of multitasking, we chose to report what we believe is most informative for policy makers, accreditation bodies, and educators [20][21][22] : (1) the overlap among the 3 major activities of direct patient care, indirect patient care, and education and (2) co-occurring indirect patient care activities. Although time spent multitasking could be interpreted as modest, whether it occurred too frequently or infrequently should be gauged by measures of interns' educational experience and how the quality of patient care was affected, which we do not measure.…”

Optimum number of procedures required to achieve procedural skills competency in internal medicine residents

“…While identification of specific procedures and number of times they need to be repeated to achieve a level of competency is a matter of debate [ 12 , 17 ], methods to determine this optimal set of numbers are also contentious. Expert consensus guidelines, although widely reported in literature [ 6 , 11 , 12 , 18 – 22 ], have been questioned due to their inherent subjectivity [ 18 , 23 , 24 ], leading to a need for more standardized and vigorous system [ 23 , 25 ]. Setting these criteria and standards has been shown to positively impact training of post graduate trainees [ 6 , 26 , 27 ].…”

The Impact of Postgraduate Training on USMLE® Step 3® and its Computer-Based Case Simulation Component

“…Additionally, the effect of postgraduate training on CCS and Step 3 overall may provide useful information for the current national debate on how to redesign internal medicine residency training and the optimal length of training. [8][9][10] For instance, there has been an ongoing debate about the necessary length of internal medicine residency; with some support to decrease the length of training to allow earlier differentiation of residents into future practice (cardiology fellowship, hospitalist, ambulatory specialist). 11,12 Alternatively, there has been support for increasing the length of internal medicine residency because of perceived lack of competency to begin practice in certain settings.…”