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

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

4. The Professional Continuum
&
Surgical Subinternship

5. AAMC: Entrustable Professional Activities (EPA)
Residents M4

6. The surgery sub I in literature
Still Not Much!

7. 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

8. 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

9. Medical student subinternships in surgery: characterization and needs assessment

10. 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%).

11. Literature Synthesis

12. 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

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

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

15. AAMC: Entrustable Professional Activities (EPA)
Residents M4

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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.

22. 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 s 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.

23. Curricular Elements

24. 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.

25. 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.

26. 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

27. Clerkship Evaluation Student feedback Faculty feedback
Monitor national trends: AAMC, ASE, ACS, APDS

28. Position Paper Update
First draft completed

29. Manuscript Revisions AAMC: EPA M3 National Curriculum Residents M4
ACS/APDS/ASE
BootCamp

30. QUESTIONS