During the final year of undergraduate medical education, students are trying to match with a compatible residency program, grow their general knowledge base and plan their longer-term career path. Research shows medical students, however, view the primary purpose of their fourth year as preparing to be an effective resident on day one.

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The result of a collaborative effort between undergraduate and graduate medical education faculty, a program at University of Rochester School of Medicine & Dentistry aims to help students accomplish that objective by emphasizing the specialty-specific skills they will need to thrive as interns.


“We understand that students, especially in the fourth year, struggle with a balance between what we want them to learn to be well-rounded doctors and their specialty-driven focus,” said David R. Lambert, MD, the senior associate dean for medical student education at Rochester. “Students often at the end of their third year know what they want to do, or at least have limited it down to one or two things, and their focus is on [pursuing that specialty] and sometimes they go off and do that seeking varying amounts of guidance.”

To help medical students hone the skills they will need as residents, Rochester has created lists of specialty-specific competencies, learning experiences and assessment opportunities that a task force of Rochester students and faculty deemed vital to success among first-year residents. The aim of the list is for fourth-year students to consult the competencies when they make their elective choices and seek advice from mentors.

“Student perception about what is best for them specialty-wise may not be what program directors perceive,” said Dr. Lambert, who presented on the program during the recent AMA ChangeMedEd™ 2017 national conference. “We decided to help them by guiding where they should put their energy in their fourth year related to specialty preparation.”

Honing the right skillset

Certain tasks, such as conducting a physical or learning a patient’s medical history, are necessary across medicine. The broadly focused medical school curriculum highlights those extensively. Rochester’s program, which is still in the pilot stage, is unusual in that looks toward a specialty before a student begins.

It makes sense. An orthopedic surgery intern well versed in perioperative evaluation on day one is going to be in a better place to succeed than one who is not.

Dr. Lambert believes the contributions made by the people running the University of Rochester Medical Center’s residency programs were invaluable in developing the checklist.

“It’s important that our own residency program directors were part of defining what these specialty-specific competencies are,” he said. “These are not what the school thinks. These are what a residency program thinks. It gives them more validity and specificity.”

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    Students dictate their success

    Rochester’s program was implemented for the first time with the class of 2017. Medical students were given the list of competencies following their third year of medical school and were urged to seek guidance about how they could assess if they have achieved the competencies.

    That put the onus on the students to be self-directed—there is no formal assessment or instruction related to the competencies, now—all are easily accomplished and feedback can be obtained from curriculum offerings.

    “The outstanding student is the outstanding student,” Dr. Lambert said. “They will benefit. However, we are hoping this will drive the student who needs more guidance, but doesn’t always listen to that guidance. It provides a more structured way for them to do A, B and C to get to a higher level.”

    The first class of students who were given the specialty-specific competencies graduated in the spring. Early returns indicate that the program was well received, with a quarter of students calling the program “essential” to their preparations for residency during a pre-graduation survey.

    The real test of the initiative’s success will come as the students begin to work as residents. Rochester plans to monitor how effective the program was by contacting former students and program directors throughout their residency. The school also plans to continue the program for the class of 2018.

    Dr. Lambert’s presentation was among dozens that took place during the ChangeMedEd conference. The event showcased how the AMA, through its Accelerating Change in Medical Education initiative, is working to reimagine and shape the future of medical education. 

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