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.
S.B. Fazio is associate professor, Department of Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
C.H. Ledford is professor, Department of Internal Medicine and Pediatrics, Ohio State University Wexner Medical College, Columbus, Ohio.
P.B. Aronowitz is professor, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California.
S.G. Chheda is associate professor, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J.H. Choe is associate professor, Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
S.A. Call is professor, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
S.D. Gitlin is professor, Department of Internal Medicine, University of Michigan and Veterans Affairs Health System, Ann Arbor, Michigan.
M. Muntz is associate professor, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
L.J. Nixon is professor, Department of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
A.G. Pereira is associate professor, Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
J.W. Ragsdale is assistant professor, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky.
E.A. Stewart is associate professor, Department of Internal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
K.E. Hauer is professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California.
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: email@example.com.
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