Reforming the Core Clerkship in Internal Medicine: The SGIM/CDIM Project

Abstract

Dramatic changes in health care have stimulated reform of undergraduate medical education. In an effort to improve the teaching of generalist competencies and encourage learning in the outpatient setting, the Society of General Internal Medicine joined with the Clerkship Directors in Internal Medicine in a federally sponsored initiative to develop a new curriculum for the internal medicine core clerkship. Using a broad-based advisory committee and working closely with key stakeholders (especially clerkship directors), the project collaborators helped forge a new national consensus on the learning agenda for the clerkship (a prioritized set of basic generalist competencies) and on the proportion of time that should be devoted to outpatient care (at least one third of the clerkship). From this consensus emerged a new curricular model that served as the basis for production of a curriculum guide and faculty resource package. The guide features the prioritized set of basic generalist competencies and specifies the requisite knowledge, skills, and attitudes/values needed to master them, as well as a list of suggested training problems. It also includes recommended training experiences, schedules, and approaches to faculty development, precepting, and student evaluation. Demand for the guide has been strong and led to production of a second edition, which includes additional materials, an electronic version, and a pocket guide for students and faculty. A follow-up survey of clerkship directors administered soon after completion of the first edition revealed widespread use of the curricular guide but also important barriers to full implementation of the new curriculum. Although this collaborative effort appears to have initiated clerkship reform, long-term success will require an enhanced educational infrastructure to support teaching in the outpatient setting.

The Oral Case Presentation: What Internal Medicine Clinician–Teachers Expect From Clinical Clerks

“…[1][2][3][4][5][6] The oral case presentation (OCP) is one of the primary media for this communication. Efforts to construct frameworks to help students create (and teachers evaluate) OCPs presuppose that medical educators share common expectations for presentations.…”

One Specialty’s Collaborative Approach to Competency-Based Curriculum Development

“…The Society of Teachers of Family Medicine (STFM) created a collaborative family medicine clerkship curriculum in 1990 9 ; a pediatric clerkship curriculum was published in 1995 by the Council on Medical Student Education in Pediatrics (COMSEP) 10 -11 ; and an internal medicine clerkship curriculum was published in 1995 by the Clerkship Directors in Internal Medicine. [12][13][14] Collaborative curriculum development is a common method of the STFM, which resembles the APA in its practice of networking around national projects. [15][16][17][18] Use of a highly collaborative process for the Guidelines was appropriate because the goal was to develop a flexible product that all residency programs could readily adapt to their own needs.…”

“…12 This BHPr-funded development project, like ours, included a collaborative process, an advisory board, and national surveys of clerkship directors to help define curriculum content. [13][14] Although these projects, and others published more recently, 24 -25 collectively included methods which we adopted or adapted, none of them has published a well-articulated model to disseminate their approaches to other groups.…”

Emergency Medicine Clerkship Directors: Defining the Characteristics of the Workforce

“…1,[4][5][6][7] Formal expectations and support materials have been developed in internal medicine for clerkship directors. [8][9][10] To date, there has been no formal evaluation of clerkship directors in emergency medicine. The objectives of this study are to define the characteristics of emergency medicine clerkship directors in the following areas: demographics, professional responsibilities, scholarly activities, faculty development, and career goals; and to evaluate determinants of scholarly productivity and job satisfaction in a manner similar to that of published reports about clerkship directors in other medical specialties.…”