Use of Large-Group Patient Rounds to Characterize Pre-clerkship Medical Students’ Ability to Perform Three Entrustable Professional Activities
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The pre-clerkship years of medical school focus on providing a foundation in the basic health sciences. Students then build on this foundation to perform clinical skills that include the American Association of Medical College’s entrustable professional activities (AAMC EPAs) targeted at day 1 of residency. A variety of educational experiences that link competencies with AAMC EPAs are needed. We used large-group physician-mentored patient rounds (PMPRs) to assess the development of three AAMC EPAs in pre-clerkship second year medical students. We focused on (1) prioritizing a differential diagnosis (AAMC EPA 2), (2) ordering diagnostic tests (AAMC EPA 3), and (3) prescribing treatments (AAMC EPA 4). We designed the PMPR described here to follow a COPD patient through history-taking, physical examination, ordering diagnostic tests, and prescription of treatments. The exercise was administered to 158 students during weekly half-hour sessions across 5 weeks. Student assignments focused on AAMC EPAs 2, 3, and 4. Student responses were collected, summarized, and shared back with critical physician appraisal of the “aggregate student thinking.” Students generally produced appropriate differential lists (AAMC EPA 2) but often exhibited naïve approaches. Students also tended to order too many and inappropriate diagnostic tests. The physician guidance resulted in students ordering fewer and more appropriate diagnostic tests (AAMC EPA 3) as the exercise progressed. Students also developed generally appropriate treatment plans (AAMC EPA 4), but a few students prescribed potentially dangerous medications which became teaching points. Large-group PMPR is an effective method for assessment of pre-clerkship medical students’ ability to perform AAMC EPAs and provides a valuable opportunity to nurture the clinical skills that are foundational to those entrustable professional activities that should be achieved before day 1 of residency.
KeywordsEntrustable professional activities Clinical reasoning Large group physician mentored patient rounds Clinical skills Pre-clerkship medical students
We would like to thank the anonymous patients who generously agreed to come before a class of medical students and share their medical stories with the hope of contributing to the next generation of high quality practitioners. We would also like to acknowledge the efforts of our students as they work toward becoming those practitioners.
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