Post-Clerkship Curricular Reform: Specialty-Specific Tracks and Entrustable Professional Activities to Guide the Transition to Residency

Abstract

The development of core entrustable professional activities (EPA) for entering residency and Accreditation Council for Graduate Medical Education’s milestones have spurred thinking about the fourth year of medical school as a transition to residency. In this monograph, we lay out our specialty focused post-clerkship curriculum and report learner and residency director perceptions over the first three years of implementation. Ongoing curricular monitoring has reinforced core principles but has also informed actionable quality improvement efforts. EPA-focused learning experiences, integration of specialty-specific milestones, addition of the feedforward process, and accessible mentorships have been key curricular elements to guide the transition to residency.

Fostering Early Preclinical Experiences for Developing Knowledge, Skills, and Confidence in Key Residency Competencies Through Participation in a Medical Student Research Training Program

“…[7][8][9] Recurrent areas of struggle include teamwork and acculturating to an interprofessional team environment, communication, self-directed and self-regulated learning, organization and time management, preventing medical errors and promoting safety, and medical knowledge. [7][8][9][10][11][12][13][14] Student-reported challenges are further corroborated by similar data from medical school faculty and residency program directors. 10,[13][14][15][16][17][18] What if UME programs looked beyond traditional mechanisms of teaching these competencies and integrated them earlier in the curriculum to gradually build students' skills in these areas?…”

“…[7][8][9][10][11][12][13][14] Student-reported challenges are further corroborated by similar data from medical school faculty and residency program directors. 10,[13][14][15][16][17][18] What if UME programs looked beyond traditional mechanisms of teaching these competencies and integrated them earlier in the curriculum to gradually build students' skills in these areas? Many medical school curricula currently include required or voluntary research projects, offer scholarly concentration programs, and/or integrate research training across the curriculum.…”

Transition to Residency Courses: Recommendations for Creation and Implementation

“…First, students have generally found learning with peers entering the same field to be valuable. 26 , 27 Specifically, one qualitative study demonstrated that graduates from TTR courses value the ability to reflect and evolve their professional identity as a resident in a specialty with a unique culture. 28 Second, allowing specialty differentiation may permit higher retention of information by decreasing the cognitive load involved in transferring learning from one specialty context to another.…”

From doing to leading: PGY‐1 to PGY‐2 transition

“…[3][4][5][6][7] The progression from undergraduate medical education to graduate medical education has been the subject of several research studies. [8][9][10][11][12][13] In contrast, transitions during residency have been less well investigated, [3][4][5]7,14 particularly in-depth explorations of trainee perspectives and emotions during this transition.…”

“…These new roles are often assumed with little more than brief resident‐as‐teacher and leadership workshops and retreats 3–7 . The progression from undergraduate medical education to graduate medical education has been the subject of several research studies 8–13 . In contrast, transitions during residency have been less well investigated, 3–5,7,14 particularly in‐depth explorations of trainee perspectives and emotions during this transition.…”