Skip to main content
SpringerLink
Log in

Core EPAs in the Acting Internship: Early Outcomes from an Interdepartmental Experience

  • Original research
  • Published:
Medical Science Educator Aims and scope Submit manuscript

Abstract

Introduction

The Core Entrustable Professional Activities for Entering Residency (Core EPAs) are clinical activities all interns should be able to perform on the first day of residency with indirect supervision. The acting (sub) internship (AI) rotation provides medical students the opportunity to be assessed on advanced Core EPAs.

Materials and Methods

All fourth-year AI students were taught Core EPA skills and performed these clinical skills under direct supervision. Formative feedback and direct observation data were provided via required workplace-based assessments (WBAs). Supervising physicians rated learner performance using the Ottawa Clinic Assessment Tool (OCAT). WBA and pre-post student self-assessment data were analyzed to assess student performance and gauge curriculum efficacy.

Results

In the 2017–2018 academic year, 167 students completed two AI rotations at our institution. By their last WBA, 91.2% of students achieved a target OCAT supervisory scale rating for both patient handoffs and calling consults. Paired sample t tests of the student pre-post surveys showed statistically significant improvement in self-efficacy on key clinical functions of the EPAs.

Discussion

This study demonstrates that the AI rotation can be structured to include a Core EPA curriculum that can assess student performance utilizing WBAs of directly observed clinical skills.

Conclusions

Our clinical outcomes data demonstrates that the majority of fourth-year medical students are capable of performing advanced Core EPAs at a level acceptable for intern year by the conclusion of their AI rotations. WBA data collected can also aid in ad hoc and longitudinal summative Core EPA entrustment decisions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Angus S, Vu TR, Halvorsen AJ, Aiyer M, McKown K, Chmielewski AF, et al. What skills should new internal medicine interns have in July? A national survey of internal medicine residency program directors. AcadMed. 2014;89:432–5.

    Google Scholar 

  2. Young JQ, Ranji SR, Wachter RM, Lee CM, Niehaus B, Auerbach AD. “July effect”: impact of the academic year-end changeover on patient outcomes: a systematic review. AnnInternMed. 2011;155:309–15.

    Google Scholar 

  3. Englander R, Flynn T, Call S, Carraccio C, Cleary L, Fulton TB, et al. Toward defining the foundation of the MD degree: Core Entrustable Professional Activities for Entering Residency. AcadMed. 2016;91:1352–8.

    Google Scholar 

  4. Wackett A, Daroowalla F, Lu W-H, Chandran L. Reforming the 4th-year curriculum as a springboard to graduate medical training: one school’s experiences and lessons learned. Teaching and Learning in Medicine. 2016;28:192–201.

    Article  Google Scholar 

  5. Fazio SB, Ledford CH, Aronowitz PB, Chheda SG, Choe JH, Call SA, et al. Competency-based medical education in the internal medicine clerkship: a report from the Alliance for Academic Internal Medicine Undergraduate Medical Education Task Force. Acad Med. 2018;93:421–7.

    Article  Google Scholar 

  6. Lindeman BM, Sacks BC, Lipsett PA. Graduating students’ and surgery program directors’ views of the Association of American Medical Colleges Core Entrustable Professional Activities for Entering Residency: where are the gaps? JSurgEduc. 2015;72:e184–92.

    Google Scholar 

  7. Meyer EG, Kelly WF, Hemmer PA, Pangaro LN. The RIME model provides a context for entrustable professional activities across undergraduate medical education. Acad Med. 2018;93:954.

    Article  Google Scholar 

  8. Benson NM, Stickle TR, Raszka WV Jr. Going “fourth” from medical school: fourth-year medical students’ perspectives on the fourth year of medical school. AcadMed. 2015;90:1386–93.

    Google Scholar 

  9. Aiyer MK, Vu TR, Ledford C, Fischer M, Durning SJ. The subinternship curriculum in internal medicine: a national survey of clerkship directors. TeachLearnMed. 2008;20:151–6.

    Google Scholar 

  10. Lindeman BM, Lipsett PA, Alseidi A, Lidor AO. Medical student subinternships in surgery: characterization and needs assessment. AmJSurg. 2013;205:175–81.

    Google Scholar 

  11. Elnicki DM, Gallagher S, Willett L, Kane G, Muntz M, Henry D, et al. Course offerings in the fourth year of medical school: how U.S. medical schools are preparing students for internship. AcadMed. 2015;90:1324–30.

    Google Scholar 

  12. Brown DR, Warren JB, Hyderi A, Drusin RE, Moeller J, Rosenfeld M, et al. Finding a path to entrustment in undergraduate medical education: a progress report from the AAMC Core Entrustable Professional Activities for Entering Residency Entrustment Concept Group. AcadMed. 2017;92:774–9.

    Google Scholar 

  13. Hauer KE, Holmboe ES, Kogan JR. Twelve tips for implementing tools for direct observation of medical trainees’ clinical skills during patient encounters. Medical Teacher. 2011;33:27–33.

    Article  Google Scholar 

  14. Ryan MS, Santen S. Generalizability of the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) scale to assess medical student performance of the Core EPAs in the workplace. Acad Med. 2020;(accepted).

  15. Garber AM, Ryan MS, Santen SA, Goldberg SR. Redefining the acting internship in the era of entrustment: one institution’s approach to reforming the acting internship. MedSciEduc [Internet]. 2019 [cited 2019 Mar 20]; Available from: https://doi.org/10.1007/s40670-019-00692-7.

  16. Starmer A, Landrigan C, Srivastava R, Wilson K, Allen A, Mahant S, et al. I-PASS handoff curriculum: faculty observation tools. MedEdPORTAL [Internet]. 2013 [cited 2019 Mar 20]; Available from: https://www.mededportal.org/publication/9570/

  17. Podolsky A, Stern DT, Peccoralo L. The courteous consult: a CONSULT card and training to improve resident consults. J Grad Med Educ. 2015;7:113–7.

    Article  Google Scholar 

  18. Rekman J, Hamstra SJ, Dudek N, Wood T, Seabrook C, Gofton W. A new instrument for assessing resident competence in surgical clinic: the Ottawa Clinic Assessment Tool. J Surg Educ. 2016;73:575–82.

    Article  Google Scholar 

  19. Klassen RM, Klassen JRL. Self-efficacy beliefs of medical students: a critical review. Perspect Med Educ. 2018;7:76–82.

    Article  Google Scholar 

  20. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. Journal of Biomedical Informatics. 2019;95:103208.

    Article  Google Scholar 

  21. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.

    Article  Google Scholar 

Download references

Funding

VCU receives funding from the Accelerating Change in Medical Education Grant from the American Medical Association. This funding was not related to this study. In addition, REDCap database access at VCU is provided through C. Kenneth and Dianne Wright Center for Clinical and Translational Research grant support (UL1TR002649).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, PO Box 980102, Richmond, VA, 23298-0102, USA

    Adam M. Garber & Stephanie R. Goldberg

  2. Center of Human Simulation and Patient Safety, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Moshe Feldman

  3. Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Michael Ryan & Sally A. Santen

  4. Virginia Commonwealth University Health System, Richmond, VA, USA

    Alan Dow

Authors
  1. Adam M. Garber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moshe Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sally A. Santen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alan Dow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephanie R. Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam M. Garber.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

This study was approved by the VCU Institutional Review Board.

Informed Consent

Not applicable

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Adam M. Garber, Associate Professor of Internal Medicine at the Virginia Commonwealth University School of Medicine.

Moshe Feldman is Associate Professor and Assistant Director for Research and Evaluation, Center of Human Simulation and Patient Safety, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

Michael Ryan, Associate Professor of Pediatrics and Assistant Dean for Clinical Medical Education at the Virginia Commonwealth University School of Medicine.

Sally A. Santen, Professor of Emergency Medicine and Senior Associate Dean for Evaluation, Assessment and Scholarship at the Virginia Commonwealth University School of Medicine.

Alan Dow, Associate Professor of Surgery at the Virginia Commonwealth University Health System.

Stephanie R. Goldberg is Associate Professor of Surgery at the Virginia Commonwealth University School of Medicine, Richmond, Virginia

Supplementary Information

ESM 1

(DOCX 21 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garber, A.M., Feldman, M., Ryan, M. et al. Core EPAs in the Acting Internship: Early Outcomes from an Interdepartmental Experience. Med.Sci.Educ. 31, 527–533 (2021). https://doi.org/10.1007/s40670-021-01208-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40670-021-01208-y

Keywords

Search

Navigation