A new study proposes that following the Match, medical school faculty should evaluate individual students and send residency program directors accurate, competency-based assessments for each graduate moving to the next level of physician training. This would ensure program directors have more detailed information on interns’ abilities and would help to identify areas where trainees need extra help, the University of Michigan Medical School authors said.

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The current medical student performance evaluation (MSPE) allows medical schools to pass on information about a student’s general competency, but it doesn’t give a high level of detail and is sent nearly a year before a graduate starts his or her residency.

Schools within the AMA’s Accelerating Change in Medical Education Consortium have been working on flexible, competency-based pathways for students in recent years, and a group at the University of Michigan—one of the 11 founding schools of the consortium—saw room for improvement.

“For this movement to succeed, medical schools must take an active role in using competency-based assessment and reliably communicating the information they garner to residency programs as part of a standardized educational handover,” noted study authors from the University of Michigan.

Members of a committee formed at the University of Michigan saw that much of the groundwork already existed to provide more detailed information. The Accreditation Council for Graduate Medical Education (ACGME) has assessments of specialty-specific milestones in place. But the competency evaluations aren’t clearly documented during the transition from undergraduate to graduate medical education, and there isn’t a clear understanding of who is supposed to ensure graduates’ level 1 competency.

To try to create a meaningful system, committee members in the spring of 2013 evaluated seven University of Michigan medical students who matched into emergency medicine residencies. The committee determined each student’s competency for the 23 emergency medicine milestones. They based their conclusions on assessments from the mandatory emergency medicine clerkship, the multi-station standardized patient exam completed at the end of the student’s third year, the emergency medicine boot camp elective and other medical school data already available.

Committee members then created a letter—a post-Match, milestone-based mMSPE—for each student. When students received a copy of the letter to review, they “reacted favorably” and made “no changes,” study authors said. The letters went to the students’ six residency program directors in July 2013 (two students headed to the same residency program). The directors also reacted positively.

Five of the six residency program directors completed a survey after they received the letter, and all of them believed the proposed assessment would be useful for all incoming interns, the study found. And four of the five responding directors said they believed the assessment provided information not available on the traditional MSPE; one director concluded the letter would allow for early intervention for areas of weakness.

Study authors said the next steps include determining the widespread usefulness of an mMSPE and gauging interest in it as a tool for all emergency medicine program directors, as well as program directors in other specialties.

“Although this ‘second dean’s letter’ does not affect residency placement … it does provide [program directors] with a more accurate and up-to-date view of the capacities of the new interns,” the authors concluded. “This information allows the [program directors] to tailor training to the strengths and weaknesses of their incoming class, which, in turn, affords the opportunity to address any weaknesses before problems arise.”

The University of Michigan will provide specialty milestone competency “handover letters” for students in pediatrics, obstetrics & gynecology, surgery and emergency medicine this year. Faculty at the University of Michigan also are working with other schools as well on the development of educational handovers. 

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