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Readiness for Residency

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Book cover Comprehensive Healthcare Simulation: Mastery Learning in Health Professions Education

Part of the book series: Comprehensive Healthcare Simulation ((CHS))

Abstract

Medical educators must ensure the readiness of medical school graduates to assume their new roles as physicians-in-training. Despite well-structured medical school curricula, scores of reports in the literature indicate that recent graduates are not adequately prepared to perform all of the tasks expected of them. In other words, gaps exist between the expectations of residency directors and the skills of new physicians. Several initiatives offer opportunities to bridge this gap. Entrustable professional activities (EPAs) offer standardized objectives for attainment of essential clinical skills among all students before graduation. Specialty-specific courses at the end of medical school are increasing, allowing students who have matched in a discipline to cement the unique skills needed for that specialty. Employing a mastery learning approach when assessing EPAs may help to ensure all graduates have achieved uniformly high performance of essential skills.

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References

  1. 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. Ann Intern Med. 2011;155(5):309–15.

    Article  PubMed  Google Scholar 

  2. Phillips DP, Barker GE. A July spike in fatal medication errors: a possible effect of new medical residents. J Gen Intern Med. 2010;25(8):774–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Jen MH, Bottle A, Majeed A, Bell D, Aylin P. Early in-hospital mortality following trainee doctors’ first day at work. PLoS One. 2009;4(9):e7103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Haller G, Myles PS, Taffé P, Perneger TV, Wu CL. Rate of undesirable events at beginning of academic year: retrospective cohort study. BMJ. 2009;339:b3974.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Barach P, Philibert I. The July effect: fertile ground for systems improvement. Ann Intern Med. 2011;155(5):331–2.

    Article  PubMed  Google Scholar 

  6. Remmen R, Scherpbier A, Derese A, Denekens J, Hermann I, van der Vleuten C, van Royen P, Bossaert L. Unsatisfactory basic skills performance by students in traditional medical curricula. Med Teach. 1998;20(6):579–82.

    Article  Google Scholar 

  7. Board P, Mercer M. A survey of the basic practical skills of final-year medical students in one UK medical school. Med Teach. 1998;20(2):104–8.

    Article  Google Scholar 

  8. Promes SB, Chudgar SM, O’Connor Grochowski C, Shayne P, Isenhour J, Glickman SW, Cairns CB. Gaps in procedural experience and competency in medical school graduates. Acad Emerg Med. 2009;16(Suppl 2):S58–62.

    Article  PubMed  Google Scholar 

  9. Kelly C, Noonan CLF, Monagle JP. Preparedness for internship: a survey of new interns in a large Victorian health service. Aust Health Rev. 2011;35(2):146–51.

    Article  PubMed  Google Scholar 

  10. Wall D, Bolshaw A, Carolan J. From undergraduate medical education to pre-registration house officer year: how prepared are students? Med Teach. 2006;28(5):435–9.

    Article  PubMed  Google Scholar 

  11. Lypson ML, Frohna JG, Gruppen LD, Woolliscroft JO. Assessing residents’ competencies at baseline: identifying the gaps. Acad Med. 2004;79(6):564–70.

    Article  PubMed  Google Scholar 

  12. Sachdeva AK, Loiacono LA, Amiel GE, Blair PG, Friedman M, Roslyn JJ. Variability in the clinical skills of residents entering training programs in surgery. Surgery. 1995;118(2):300–8.

    Article  CAS  PubMed  Google Scholar 

  13. Moercke AM, Eika B. What are the clinical skills levels of newly graduated physicians? Self-assessment study of an intended curriculum identified by a Delphi process. Med Educ. 2002 May;36(5):472–8.

    Article  PubMed  Google Scholar 

  14. Barnsley L, Lyon PM, Ralston SJ, Hibbert EJ, Cunningham I, Gordon FC, Field MJ. Clinical skills in junior medical officers: a comparison of self-reported confidence and observed competence. Med Educ. 2004;38(4):358–67.

    Article  PubMed  Google Scholar 

  15. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094–102.

    Article  CAS  PubMed  Google Scholar 

  16. Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999 Dec;77(6):1121–34.

    Article  CAS  PubMed  Google Scholar 

  17. Burch VC, Nash RC, Zabow T, Gibbs T, Aubin L, Jacobs B, Hift RJ. A structured assessment of newly qualified medical graduates. Med Educ. 2005;39(7):723–31.

    Article  CAS  PubMed  Google Scholar 

  18. 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? J Surg Educ. 2015;72(6):e184–92.

    Article  PubMed  Google Scholar 

  19. Dickson GM, Chesser AK, Woods NK, Krug NR, Kellerman RD. Family medicine residency program director expectations of procedural skills of medical school graduates. Fam Med. 2013;45(6):392–9.

    PubMed  Google Scholar 

  20. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system--rationale and benefits. N Engl J Med. 2012;366(11):1051–6. https://doi.org/10.1056/NEJMsr1200117. Epub 2012 Feb 22.

    Article  CAS  PubMed  Google Scholar 

  21. Santen SA, Rademacher N, Heron SL, Khandelwal S, Hauff S, Hopson L. How competent are emergency medicine interns for level 1 milestones: who is responsible? Acad Emerg Med. 2013;20(7):736–9.

    Article  PubMed  Google Scholar 

  22. ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39(12):1176–7.

    Article  PubMed  Google Scholar 

  23. Association of American Medical Colleges. Core entrustable professional activities for entering residency. 2013. https://www.mededportal.org/icollaborative/resource/887. Accessed 7/1/19.

  24. Core Entrustable Professional Activities for Entering Residency – Curriculum Developers Guide. https://store.aamc.org/core-entrustable-professional-activities-for-entering-residency.html. Accessed 7/1/19.

  25. Ten Cate O. Trusting graduates to enter residency: what does it take? J Grad Med Educ. 2014;6(1):7–10.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kennedy TJ, Regehr G, Baker GR, Lingard L. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008;83(10 Suppl):S89–92.

    Article  PubMed  Google Scholar 

  27. Hauer KE, Ten Cate O, Boscardin C, Irby DM, Iobst W, O’Sullivan PS. Understanding trust as an essential element of trainee supervision and learning in the workplace. Adv Health Sci Educ Theory Pract. 2014;19(3):435–56.

    PubMed  Google Scholar 

  28. Chen HC, van den Broek WE, ten Cate O. The case for use of entrustable professional activities in undergraduate medical education. Acad Med. 2015;90:431–6.

    Article  PubMed  Google Scholar 

  29. George BC, Teitelbaum EN, Meyerson SL, Schuller MC, DaRosa DA, Petrusa ER, Petito LC, Fryer JP. Reliability, validity, and feasibility of the Zwisch scale for the assessment of intraoperative performance. J Surg Educ. 2014;71(6):e90–6.

    Article  PubMed  Google Scholar 

  30. Rekman J, Gofton W, Dudek N, Gofton T, Hamstra SJ. Entrustability scales: outlining their usefulness for competency-based clinical assessment. Acad Med. 2016;91(2):186–90.

    Article  PubMed  Google Scholar 

  31. McGaghie WC. Mastery learning: it is time for medical education to join the 21st century. Acad Med. 2015;90(11):1438–41.

    Article  PubMed  Google Scholar 

  32. Aylward M, Nixon J, Gladding S. An entrustable professional activity (EPA) for handoffs as a model for EPA assessment development. Acad Med. 2014;89(10):1335–40.

    Article  PubMed  Google Scholar 

  33. Baker EA, Ledford CH, Fogg L, Way DP, Park YS. The IDEA assessment tool: assessing the reporting, diagnostic reasoning, and decision-making skills demonstrated in medical students’ hospital admission notes. Teach Learn Med. 2015;27(2):163–73.

    Article  PubMed  Google Scholar 

  34. Bierman JA, Hufmeyer KK, Liss DT, Weaver AC, Heiman HL. Promoting responsible electronic documentation: validity evidence for a checklist to assess progress notes in the electronic health record. Teach Learn Med. 2017;29(4):420–32.

    Article  PubMed  Google Scholar 

  35. Heiman HL, Uchida T, Adams C, Butter J, Cohen E, Persell SD, Pribaz P, McGaghie WC, Martin GJ. E-learning and deliberate practice for oral case presentation skills: a randomized trial. Med Teach. 2012;34(12):e820–6.

    Article  PubMed  Google Scholar 

  36. Salzman DH, McGaghie WC, Caprio T, Even EA, Hufmeyer K, Issa N, Schaefer E, Trainor J, Wayne DB. Use of a simulation-based capstone course to teach and assess Entrustable professional activities to graduating medical students. Med Sci Educ. 2016;26:453–6.

    Article  Google Scholar 

  37. Pereira AG, Harrell HE, Weissman A, Smith CD, Dupras D, Kane GC. Important skills for internship and the fourth-year medical school courses to acquire them: a national survey of internal medicine residents. Acad Med. 2016;91(6):821–6.

    Article  PubMed  Google Scholar 

  38. Lyss-Lerman P, Teherani A, Aagaard E, Loeser H, Cooke M, Harper GM. What training is needed in the fourth year of medical school? Views of residency program directors. Acad Med. 2009;84(7):823–9.

    Article  PubMed  Google Scholar 

  39. Esterl RM, Henzi DL, Cohn SM. Senior medical student “Boot Camp”: can result in increased self-confidence before starting surgery internships. Curr Surg. 2006;63(4):264–8.

    Article  PubMed  Google Scholar 

  40. Peyre SE, Peyre CG, Sullivan ME, Towfigh S. A surgical skills elective can improve student confidence prior to internship. J Surg Res. 2006;133(1):11–5.

    Article  PubMed  Google Scholar 

  41. Okusanya OT, Kornfield ZN, Reinke CE, Morris JB, Sarani B, Williams NN, Kelz RR. The effect and durability of a pregraduation boot cAMP on the confidence of senior medical student entering surgical residencies. J Surg Educ. 2012;69(4):536–43.

    Article  PubMed  Google Scholar 

  42. Naylor RA, Hollett LA, Castellvi A, Valentine RJ, Scott DJ. Preparing medical students to enter surgery residencies. Am J Surg. 2010;199(1):105–9.

    Article  PubMed  Google Scholar 

  43. Antonoff MB, Swanson JA, Green CA, Mann BD, Maddaus MA, D’Cunha J. The significant impact of a competency-based preparatory course for senior medical students entering surgical residency. Acad Med. 2012;87(3):308–19.

    Article  PubMed  Google Scholar 

  44. Lamba S, Wilson B, Natal B, Nagurka R, Anana M, Sule H. A suggested emergency medicine boot camp curriculum for medical students based on the mapping of Core Entrustable Professional Activities to Emergency Medicine Level 1 milestones. Adv Med Educ Pract. 2016;7:115–24.

    PubMed  PubMed Central  Google Scholar 

  45. Morgan H, Marzano D, Lanham M, Stein T, Curran D, Hammoud M. Preparing medical students for obstetrics and gynecology milestone level one: a description of a pilot curriculum. Med Educ Online. 2014;19:25746.

    Article  PubMed  Google Scholar 

  46. Morgan H, Skinner B, Marzano D, Fitzgerald J, Curran D, Hammoud M. Improving the medical school-residency transition. Clin Teach. 2017;14(5):340–3.

    Article  PubMed  Google Scholar 

  47. Burns R, Adler M, Mangold K, Trainor J. A brief boot camp for 4th-year medical students entering into pediatric and family medicine residencies. Cureus. 2016;8(2):e488. https://doi.org/10.7759/cureus.488.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Bontempo LJ, Frayha N, Dittmar PC. The internship preparation camp at the University of Maryland. Postgrad Med J. 2017 Jan;93(1095):8–14.

    Article  PubMed  Google Scholar 

  49. Clay AS, Andolsek K, Grochowski CO, Engle DL, Chudgar SM. Using transitional year milestones to assess graduating medical students’ skills during a capstone course. J Grad Med Educ. 2015;7(4):658–62.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Parent RJ, Plerhoples TA, Long EE, Zimmer DM, Teshome M, Mohr CJ, Ly DP, Hernandez-Boussard T, Curet MJ, Dutta S. Early, intermediate, and late effects of a surgical skills “boot camp” on an objective structured assessment of technical skills: a randomized controlled study. J Am Coll Surg. 2010;210(6):984–9.

    Article  PubMed  Google Scholar 

  51. Fernandez GL, Page DW, Coe NP, Lee PC, Patterson LA, Skylizard L, St Louis M, Amaral MH, Wait RB, Seymour NE. Boot cAMP: educational outcomes after 4 successive years of preparatory simulation-based training at onset of internship. J Surg Educ. 2012;69(2):242–8.

    Article  PubMed  Google Scholar 

  52. Aylward M, Vawter L, Roth C. An interactive handoff workshop to improve intern readiness in patient care transitions. J Grad Med Educ. 2012;4(1):68–71.

    Article  PubMed  PubMed Central  Google Scholar 

  53. American Board of Surgery; American College of Surgeons; Association of Program Directors in Surgery; Association for Surgical Education. Statement on surgical preresidency preparatory courses. J Surg Educ. 2014;71(6):777–8.

    Article  Google Scholar 

  54. Selden NR, Origitano TC, Burchiel KJ, Getch CC, Anderson VC, McCartney S, Abdulrauf SI, Barrow DL, Ehni BL, Grady MS, Hadjipanayis CG, Heilman CB, Popp AJ, Sawaya R, Schuster JM, Wu JK, Barbaro NM. A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery. 2012;70(4):971–81.

    Article  PubMed  Google Scholar 

  55. Minha S, Shefet D, Sagi D, Berkenstadt H, Ziv A. “See one, sim one, do one”- a national pre-internship boot-camp to ensure a safer “student to doctor” transition. PLoS One. 2016;11(3):e0150122.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Butter J, McGaghie WC, Cohen ER, Kaye M, Wayne DB. Simulation-based mastery learning improves cardiac auscultation skills in medical students. J Gen Intern Med. 2010;25(8):780–5.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Cohen ER, Barsuk JH, Moazed F, Caprio T, Didwania A, McGaghie WC, Wayne DB. Making July safer: simulation-based mastery learning during intern boot camp. Acad Med. 2013;88(2):233–9.

    Article  PubMed  Google Scholar 

  58. Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB. Clinical outcomes after bedside and interventional radiology paracentesis procedures. Am J Med. 2013;126(4):349–56.

    Article  PubMed  Google Scholar 

  59. Reed T, Pirotte M, McHugh M, Oh L, Lovett S, Hoyt AE, Quinones D, Adams W, Gruener G, McGaghie WC. Simulation-based mastery learning improves medical student performance and retention of core clinical skills. Sim Healthc. 2016;11(3):173–80.

    Article  Google Scholar 

  60. Salzman DH, McGaghie WC, Caprio T, Hufmeyer K, Issa N, Trainor J, Cohen E, Wayne DB. A mastery learning capstone course to teach and assess components of three entrustable professional activities to graduating medical students. Teach Learn Med. 2019;31(2):186–94.

    Article  PubMed  Google Scholar 

  61. Arora VM, Berhie S, Horwitz LI, Saathoff M, Staisiunas P, Farnan JM. Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise. J Hosp Med. 2014;9(7):441–6.

    Article  PubMed  Google Scholar 

  62. Massagli TL, Carline JD. Reliability of a 360-degree evaluation to assess resident competence. Am J Phys Med Rehabil. 2007;86(10):845–52.

    Article  PubMed  Google Scholar 

  63. Norcini JJ, Blank LL, Arnold GK, Kimball HR. The mini-CEX (clinical evaluation exercise): a preliminary investigation. Ann Intern Med. 1995;123(10):795–9.

    Article  CAS  PubMed  Google Scholar 

  64. Norcini JJ, Blank LL, Duffy FD, Fortna GS. The mini-CEX: a method for assessing clinical skills. Ann Intern Med. 2003;138(6):476–81.

    Article  PubMed  Google Scholar 

  65. Kogan JR, Bellini LM, Shea JA. Implementation of the mini-CEX to evaluate medical students’ clinical skills. Acad Med. 2002;77(11):1156–1157.4.

    Article  PubMed  Google Scholar 

  66. Weller JM, Jolly B, Misur MP, Merry AF, Jones A, Crossley JG, Pedersen K, Smith K. Mini-clinical evaluation exercise in anaesthesia training. Br J Anaesth. 2009;102(5):633–41.

    Article  CAS  PubMed  Google Scholar 

  67. Ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using entrustable professional activities (EPAs): AMEE guide no. 99. Med Teach. 2015;37(11):983–1002.

    Article  PubMed  Google Scholar 

  68. Walling A, Merando A. The fourth year of medical education: a literature review. Acad Med. 2010;85(11):1698–704.

    Article  PubMed  Google Scholar 

  69. Andrews JS, Bale JF, Soep JB, Long M, Carraccio C, Englander R, Powell D, EPAC Study Group. Education in pediatrics across the continuum (EPAC): first steps toward realizing the dream of competency-based education. Acad Med. 2018;93(3):414–20.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Northwestern University Feinberg School of Medicine, Departments of Emergency Medicine and Medical Education, Chicago, IL, USA

    David H. Salzman

  2. Northwestern University Feinberg School of Medicine, Departments of Medicine and Medical Education, Chicago, IL, USA

    Heather L. Heiman & Brigid M. Dolan

  3. Northwestern University Feinberg School of Medicine, Departments of Pediatrics and Medical Education, Chicago, IL, USA

    Jennifer Trainor

Authors
  1. David H. Salzman
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  2. Heather L. Heiman
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  3. Brigid M. Dolan
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  4. Jennifer Trainor
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Correspondence to David H. Salzman .

Editor information

Editors and Affiliations

  1. Northwestern University Feinberg School of Medicine, Departments of Medical Education and Preventive Medicine, Chicago, IL, USA

    William C. McGaghie

  2. Northwestern University Feinberg School of Medicine, Departments of Medicine and Medical Education, Chicago, IL, USA

    Jeffrey H. Barsuk

  3. Northwestern University Feinberg School of Medicine, Departments of Medicine and Medical Education, Chicago, IL, USA

    Diane B. Wayne

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Salzman, D.H., Heiman, H.L., Dolan, B.M., Trainor, J. (2020). Readiness for Residency. In: McGaghie, W., Barsuk, J., Wayne, D. (eds) Comprehensive Healthcare Simulation: Mastery Learning in Health Professions Education. Comprehensive Healthcare Simulation. Springer, Cham. https://doi.org/10.1007/978-3-030-34811-3_15

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  • DOI: https://doi.org/10.1007/978-3-030-34811-3_15

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