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What Skills Should New Internal Medicine Interns Have in July? A National Survey of Internal Medicine Residency Program Directors

Angus, Steven MD; Vu, T. Robert MD; Halvorsen, Andrew J. MS; Aiyer, Meenakshy MD; McKown, Kevin MD; Chmielewski, Amy F.; McDonald, Furman S. MD, MPH

doi: 10.1097/ACM.0000000000000133
Innovation Reports

Problem The transition from medical student to intern may cause stress and burnout in new interns and the delivery of suboptimal patient care. Despite a formal set of subinternship curriculum guidelines, program directors have expressed concern regarding the skill set of new interns and the lack of standardization in that skill set among interns from different medical schools. To address these issues, the Accreditation Council for Graduate Medical Education’s Next Accreditation System focuses on the development of a competency-based education continuum spanning undergraduate, graduate, and continuing medical education.

Approach In 2010, the Clerkship Directors in Internal Medicine subinternship task force, in collaboration with the Association of Program Directors in Internal Medicine survey committee, surveyed internal medicine residency program directors to determine which competencies or skills they expected from new medical school graduates. The authors summarized the results using categories of interest.

Outcomes In both an item rank list and free-text responses, program directors were nearly uniform in ranking the skills they deemed most important for new interns—organization and time management and prioritization skills; effective communication skills; basic clinical skills; and knowing when to ask for assistance.

Next Steps Stakeholders should use the results of this survey as they develop a milestone-based curriculum for the fourth year of medical school and for the internal medicine subinternship. By doing so, they should develop a standardized set of skills that meet program directors’ expectations, reduce the stress of transitions across the educational continuum, and improve the quality of patient care.

Dr. Angus is program director, Internal Medicine Residency Program, vice chair of education, and associate professor of medicine, University of Connecticut School of Medicine, Farmington, Connecticut.

Dr. Vu is associate professor of clinical medicine and medicine clerkship director, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.

Mr. Halvorsen is project & data manager, Internal Medicine Residency Office of Educational Innovations, Department of Medicine, Mayo Clinic, Rochester, Minnesota.

Dr. Aiyer is associate professor of clinical medicine, University of Illinois College of Medicine, Peoria, Illinois.

Dr. McKown is associate professor of medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Ms. Chmielewski is program coordinator, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.

Dr. McDonald is professor of medicine, Mayo Clinic, Rochester, Minnesota.

Funding/Support: This study was supported in part by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations as part of the Accreditation Council for Graduate Medical Education Educational Innovations Project. The authors are grateful to the Mayo Clinic Survey Research Center for assistance with the survey design and data collection.

Other disclosures: None reported.

Ethical approval: The Mayo Clinic institutional review board approved this study.

Correspondence should be addressed to Dr. Angus, 263 Farmington Ave., Mail Code 1235, Farmington, CT 06030; telephone: (860) 679-2562; e-mail:

© 2014 by the Association of American Medical Colleges