M4 Interest Group- 2014 Nabil Issa, MD- Director, Surgery Subinternship Northwestern University Feinberg School of Medicine

What we’ll talk about The professional continuum & surgical sub-I The sub-I in literature Position paper- recommendation threads

The Professional Continuum & Surgical Subinternship

AAMC: Entrustable Professional Activities (EPA) Residents M4

The surgery sub I in literature Still Not Much!

What competencies are deficient among surgical interns in particular? Two studies have explored this topic: ACS/APDS/ASE National Preparatory Surgery Curriculum Medical student subinternships in surgery: characterization and needs assessment

ACS/APDS/ASE National Preparatory Surgery Curriculum Needs Assessment- Main findings: Anxiety /deficient technical skills Managing multiple simultaneous demands Managing critical/unstable patients Management of Post-op conditions Difficult communications

Medical student subinternships in surgery: characterization and needs assessment

Findings Subinternship curriculum elements perceived benefit to student education Less than half of students enrolled in general surgery subinternship courses received formal objectives. Only 10% of students received a detailed reading schedule or list for the rotation . Almost all respondents answered that a review of basic technical topics (94%) and a workshop (95%) on common calls would be important but only 21% and 8% respectively were able to participate in these activities during their subinternship. Patient was the most common activity cited as part of a surgical subinternship (n= 191, 74%).

Literature Synthesis

What students want is more organized educational activities! Formal objectives. Reading list. Review common call problems. Procedures laboratory. Dedicated time with faculty. Direct responsibility. Autonomy. Receive formal objectives Reading list for the rotation Review common call problems Basic bedside procedures laboratory Dedicated teaching time with faculty/seniors for teaching and feedback Increased autonomy in decision making Increased direct responsibility for patient care

M4- Interest group: Alan Ladd, Steven Goldin, Anne Lidor, Nabil Issa Position Paper M4- Interest group: Alan Ladd, Steven Goldin, Anne Lidor, Nabil Issa

Conceptual Framework AAMC: EPA M3 National Curriculum ACS/APDS/ASE Residents M4 AAMC: EPA M3 National Curriculum ACS/APDS/ASE Boot Camp

AAMC: Entrustable Professional Activities (EPA) Residents M4

Recommendation Threads Administrative Structure Goals and Objectives Curricular elements Instructional strategies Assessment tools Clerkship evaluation Have a dedicated coordinator of educational activities Provide explicit set of educational objectives Dedicated conferences to stress patient management issues Able to write medical orders with co-signature Participate in supervised cross-coverage

Administrative Structure M3 ≠ M4 creating an administrative structure for the rotation that is separate from that of the M3 surgery clerkship with a dedicated coordinator of educational activities

Administrative Structure M3 ≠ M4 M3 Director M4 Director creating an administrative structure for the rotation that is separate from that of the M3 surgery clerkship with a dedicated coordinator of educational activities Coordinator Coordinator

Administrative Structure M3 ≠ M4 M3 Director M4 Director creating an administrative structure for the rotation that is separate from that of the M3 surgery clerkship with a dedicated coordinator of educational activities Coordinator

Administrative Structure M3 ≠ M4 M3/M4 Director creating an administrative structure for the rotation that is separate from that of the M3 surgery clerkship with a dedicated coordinator of educational activities Coordinator Coordinator

Role of Sub-I Director Create curriculum: M3 → Residency Explicit goals & objectives Comprehensive orientation Choice of clinical rotations Petition school for resources Protected educational time Career coach The subinternship director will also act as a career advisor, and a coach for students interested in pursuing careers in surgery. This includes providing advice on choosing mentors, identifying research and leadership opportunities, assisting with personal statement writing, choosing institutional and away clinical rotations, assisting with the residency application process, and the rank list, developing mock interviews and interview coaching, among other tasks deemed important for student placement into surgical residency programs.

Role of Sub-I Coordinator Coordinating educational activities Administrative link to school and department policies, rules and announcements Documentation: student and rotation activities Weekly follow up e-mails to enforce task completion Administrative timelines The subinternship director will also act as a career advisor, and a coach for students interested in pursuing careers in surgery. This includes providing advice on choosing mentors, identifying research and leadership opportunities, assisting with personal statement writing, choosing institutional and away clinical rotations, assisting with the residency application process, and the rank list, developing mock interviews and interview coaching, among other tasks deemed important for student placement into surgical residency programs.

Curricular Elements

Goals and Objectives 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 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 End of rotation project or assay.

Assessment Tools Composite Scoring: Appraisals of clinical performance Performance on mock pages Participation in discussion during Prof. rounds Procedural competence 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 Residents M4 ACS/APDS/ASE BootCamp

QUESTIONS