M4 Interest Group- 2014
Nabil Issa, MD- Director, Surgery Subinternship
Northwestern University Feinberg School of Medicine
What we’ll talk about
1. The professional continuum & surgical sub-I
2. The sub-I in literature
3. Position paper- recommendation threads
The Professional Continuum
&
Surgical Subinternship
AAMC:
Entrustable Professional Activities (EPA)
Residents
M4
M3
M1-2
The surgery sub I in literature
Still Not Much!
What competencies are deficient
among surgical interns in particular?
Two studies have explored this topic:
I. ACS/APDS/ASE National Preparatory Surgery
Curriculum
II. Medical student subinternships in surgery:
characterization and needs assessment
ACS/APDS/ASE National Preparatory
Surgery Curriculum
 Needs Assessment- Main findings:
1. Anxiety /deficient technical skills
2. Managing multiple simultaneous demands
3. Managing critical/unstable patients
4. Management of Post-op conditions
5. Difficult communications
Medical student subinternships in surgery:
characterization and needs assessment
Findings
Subinternship curriculum elements perceived benefit to student
education
Literature Synthesis
What students want is more
organized educational activities!
1.
2.
3.
4.
5.
6.
7.
Formal objectives.
Reading list.
Review common call problems.
Procedures laboratory.
Dedicated time with faculty.
Direct responsibility.
Autonomy.
Position Paper
M4- Interest group:
Alan Ladd, Steven Goldin, Anne Lidor,
Nabil Issa
Conceptual Framework
AAMC: EPA
M3 National Curriculum
ACS/APDS/ASE
Boot Camp
M3
M1-2
Residents
M4
AAMC:
Entrustable Professional Activities (EPA)
Residents
M4
M3
M1-2
Recommendation Threads
1.
2.
3.
4.
5.
6.
Administrative Structure
Goals and Objectives
Curricular elements
Instructional strategies
Assessment tools
Clerkship evaluation
Administrative Structure
M3 ≠ M4
Administrative Structure
M3 ≠ M4
M3 Director
M4 Director
Coordinator
Coordinator
Administrative Structure
M3 ≠ M4
M3 Director
M4 Director
Coordinator
Administrative Structure
M3 ≠ M4
M3/M4 Director
Coordinator
Coordinator
Role of Sub-I Director
1.
2.
3.
4.
5.
6.
7.
Create curriculum: M3 → Residency
Explicit goals & objectives
Comprehensive orientation
Choice of clinical rotations
Petition school for resources
Protected educational time
Career coach
Role of Sub-I Coordinator
1. Coordinating educational activities
2. Administrative link to school and department
policies, rules and announcements
3. Documentation: student and rotation
activities
4. Weekly follow up e-mails to enforce task
completion
5. Administrative timelines
Curricular Elements
Goals and Objectives
1.
2.
3.
4.
5.
6.
7.
8.
H&P skills: Concise & pertinent.
Clear progress notes.
Advanced clinical reasoning.
Manage common surgical problems.
Perform common bedside procedures.
Patient handoffs during transitions of care.
Professional communications.
Utilize informatics.
Instructional Strategies
1.
2.
3.
4.
5.
6.
Direct observations: H&P/DDx/management plans
Professor rounds: case-based discussions
Mock pages: common problems
Web-based modules: SBAR/Handoffs
Technical skills lab: common bedside procedures
Independent reading: pt. safety/quality controls/
evidence-based medicine
7. End of rotation project or assay.
Assessment Tools
Composite Scoring:
1. Appraisals of clinical performance
2. Performance on mock pages
3. Participation in discussion during Prof. rounds
4. Procedural competence
5. Professionalism: timely completion of tasks
Clerkship Evaluation
• Student feedback
• Faculty feedback
• Monitor national trends: AAMC, ASE, ACS,
APDS
Position Paper Update
First draft completed
Manuscript Revisions
AAMC: EPA
M3 National
Curriculum
ACS/APDS/ASE
BootCamp
Residents
M4
M3
M1-2
QUESTIONS