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Competency-Based Medical Education in the Internal Medicine Clerkship: A Report From the Alliance for Academic Internal Medicine Undergraduate Medical Education Task Force

Fazio Sara B. MD; Ledford, Cynthia H. MD; Aronowitz, Paul B. MD; Chheda, Shobhina G. MD, MPH; Choe, John H. MD, MPH; Call, Stephanie A. MD; Gitlin, Scott D. MD; Muntz, Marty MD; Nixon, L. James MD, MHPE; Pereira, Anne G. MD, MPH; Ragsdale, John W. MD, MS; Stewart, Emily A. MD; Hauer, Karen E. MD, PhD
doi: 10.1097/ACM.0000000000001896
Article: PDF Only

As medical educators continue to redefine learning and assessment across the continuum, implementation of competency-based medical education in the undergraduate setting has become a focus of many medical schools. While standards of competency have been defined for the graduating student, there is no uniform approach for defining competency expectations for students during their core clerkship year. The authors describe the process by which an Alliance for Academic Internal Medicine task force developed a paradigm for competency-based assessment of students during their inpatient internal medicine (IM) clerkship. Building on work at the resident and fellowship levels, the task force focused on the development of key learning outcomes as defined by entrustable professional activities (EPAs) that were specific to educational experiences on the IM clerkship, as well as identification of high-priority assessment domains. The work was informed by a national survey of clerkship directors.

Six key EPAs emerged: generating a differential diagnosis, obtaining a complete and accurate history and physical exam, obtaining focused histories and clinically relevant physical exams, preparing an oral presentation, interpreting the results of basic diagnostic studies, and providing well-organized clinical documentation. A model for assessment was proposed, with descriptors aligned to the scale of supervision and mapped to Accreditation Council for Graduate Medical Education domains of competence. The proposed paradigm offers a standardized template that may be used across IM clerkships, and which would effectively bridge competency evaluation in the clerkship to fourth-year assessment as well as eventual postgraduate training.

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: The institutional review board (IRB) at the University of Texas Medical Branch determined that the CDIM Survey research protocol did not fit the definition of human subjects research, and, therefore, the protocol did not require exemption status, further IRB review, or IRB approval.

Previous presentations: The entrustable professional activity data were presented at a plenary at the national CDIM conference in Atlanta, Georgia, October 10, 2015.

Correspondence should be addressed to Sara B. Fazio, Beth Israel Deaconess Medical Center, Department of Internal Medicine, 330 Brookline Ave., Boston, MA 02215; telephone: (617) 667-9600; e-mail: sfazio@bidmc.harvard.edu.

© 2017 by the Association of American Medical Colleges