Enhancing Surgical Subinternships: A Roadmap for Success

2. M4 Interest Group- 2014Nabil Issa, MD- Director, Surgery SubinternshipNorthwestern 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)

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

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.

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

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

15. AAMC: Entrustable Professional Activities (EPA)

16. Recommendation Threads • Administrative Structure • Goals and Objectives • Curricular elements • Instructional strategies • Assessment tools • Clerkship evaluation

17. Administrative Structure M3 ≠ M4

18. Administrative Structure M3 ≠ M4 M3 Director M4 Director Coordinator Coordinator

19. Administrative Structure M3 ≠ M4 M3 Director M4 Director Coordinator

20. Administrative Structure M3 ≠ M4 M3/M4 Director 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

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 e-mails to enforce task completion • Administrative timelines

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 ACS/APDS/ASE BootCamp

30. QUESTIONS