Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Moving Toward Summative Competency Assessment to Individualize the Postclerkship Phase

Keeley, Meg G. MD; Gusic, Maryellen E. MD; Morgan, Helen K. MD; Aagaard, Eva M. MD; Santen, Sally A. MD, PhD

doi: 10.1097/ACM.0000000000002830

In the move toward competency-based medical education, leaders have called for standardization of learning outcomes and individualization of the learning process. Significant progress has been made in establishing defined expectations for the knowledge, skills, attitudes, and behaviors required for successful transition to residency training, but individualization of educational processes to assist learners in reaching these competencies has been predominantly conceptual to date. The traditional time-based structure of medical education has posed a challenge to individualization within the curriculum and has led to more attention on innovations that facilitate transition from medical school to residency. However, a shift of focus to the clerkship-to-postclerkship transition point in the undergraduate curriculum provides an opportunity to determine how longitudinal competency-based assessments can be used to facilitate intentional and individualized structuring of the long-debated fourth year.

This Perspective demonstrates how 2 institutions—the University of Virginia School of Medicine and the University of Michigan Medical School—are using competency assessments and applying standardized outcomes in decisions about individualization of the postclerkship learning process. One institution assesses Core Entrustable Professional Activities for Entering Residency, whereas the other has incorporated Accreditation Council for Graduate Medical Education core competencies and student career interests to determine degrees of flexibility in the postclerkship phase. Individualization in addition to continued assessment of performance presents an opportunity for intentional use of curriculum time to develop each student to be competently prepared for the transition to residency.

M.G. Keeley is assistant dean for student affairs, director of the fourth-year program, and professor of pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia; ORCID:

M.E. Gusic is senior advisor in educational affairs and professor of medical education, University of Virginia School of Medicine, Charlottesville, Virginia.

H.K. Morgan is associate professor of learning health sciences and associate professor of obstetrics and gynecology, University of Michigan Medical School, Ann Arbor, Michigan.

E.M. Aagaard is senior associate dean for education and professor of medicine, Washington University School of Medicine, St. Louis, Missouri.

S.A. Santen is senior associate dean for assessment, evaluation, and scholarship and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

Funding/Support: None reported.

Other disclosures: The University of Michigan Medical School and S.A. Santen receive funding from an American Medical Association Accelerating Change in Medical Education grant.

Ethical approval: Reported as not applicable.

Previous presentation: This study was presented at Learn Serve Lead: The AAMC Annual Meeting; November 6, 2017; Boston, Massachusetts.

Correspondence should be addressed to Meg G. Keeley, University of Virginia School of Medicine, Box 800739, Charlottesville, VA 22908; telephone: (434) 924-5579; email:

Copyright © 2019 by the Association of American Medical Colleges