For the medical industry, change seems to be the only constant. The federal government recently implemented the Affordable Care Act, a nationwide health initiative that's changing the health insurance market. Next year, the Association of American Medical Colleges will roll out a brand new MCAT, an admissions exam that helps determine who gets into medical school and who does not. Another major change in the works will shape the way medical students prepare for residencies. The Association for American Medical Colleges in June announced the creation of a new set of guidelines, known as the Core Entrustable Professional Activities for Entering Residency. Medical schools can use them to help students transition to a residency program. In residency, new doctors receive additional training for what usually lasts three or more years. "There has been a growing literature that looks at the expectations of program directors versus performance of students or new residents on day one, and showing that there’s a gap there," says Bob Englander, the senior director for competency-based learning and assessment at the association. "What they expect and what they’re actually able to do on day one is not always the same." The new guidelines aim to eliminate this gap. They identify 13 activities that all new residents should be able to do on their first day, such as perform a physical exam on a patient, write a medical order and form clinical questions and retrieve evidence, says Englander. Those are the kinds of things that have a potentially big impact if people aren't able to do them on arrival, he says. In September the association announced a pilot cohort of 10 schools that will help test the implementation of the guidelines by tweaking their curriculum and possibly establishing new ways to ensure that students can do the 13 activities. The cohort includes the School of Medicine at Vanderbilt University, the School of Medicine at New York University, the College of Human Medicine at Michigan State University and University of Illinois College of Medicine. It will last for five years, Englander says, and have its first group meeting this month. Schools have already started working on how to better prepare residents. At Michigan State University, "We’re already doing a lot of simulation work around several of these activities," says Dianne Wagner, the associate dean for collegewide assessment and a professor of medicine at the school. In simulations, medical students practice their skills with highly trained actors who pretend to be patients. One of the simulations Michigan students practice, she says, is knowing how to turn over the patients they've been responsible for to another physician once they're off duty – a skill that the new recommendations highlight. "We’re developing standardized ways to communicate what needs to be understood about those patients for the doctor who’s taking over," she says. "It's an important piece of what needs to be done." Michigan students also use simulations to practice what's become the first of the guidelines' activities, which is gathering a patient's history and performing a physical examination, an activity that most medical students can usually manage on the first day of residency, Englander says. Vanderbilt University is also using simulations to train students, but it's also implemented some other changes that make its medical school curriculum unlike many. Second-year students go into hospitals to begin their clerkships, says Kimberly Lomis, the associate dean for undergraduate medical education, a common term used by medical professionals for medical school. In many schools, students don't begin hospital clerkships, which involve hands-on medical training, until their third year. Students also have a digital portfolio, which includes assessments of their skills. They work with a coach to keep track of their strengths and weaknesses, which are highlighted in the assessment, and the coach guides them on how to improve. Unlike many school structures, this one allows the school's medical students to focus on more than getting good grades and showing others where they excel. It's okay to say where you're struggling. "Some of the students actually have referred to it as liberating," Lomis says. Many of the schools not involved in the pilot are still working on curriculum innovation that's in line with the new guidelines, Englander says. For prospective medical students who are already thinking about which schools will best prepare them for residency, Englander suggests they focus on something else. "What you should primarily be thinking about is which school do you think will best prepare you to be a physician," he says. "Residency is an incredibly important stage in that formation, but ultimately the goal is to be a great physician." Source
