Fostering competence: Medical school to test guidelines for entering residency

VCU School of Medicine selected as one of 10 schools nationwide to test guidelines for entering residency

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Medical students are taught how to gather patient histories and perform physical examinations on the first day of school, but whether they’ve mastered those skills by the time they graduate has recently been called into question.

“The question is, when is someone trustworthy enough to be able to do that without direct supervision, which is what they’re going to need to be able to do on their first day of residency,” said Michael S. Ryan, M.D., assistant dean for clinical medical education, Virginia Commonwealth University School of Medicine.

Ryan is leading VCU’s involvement in a national pilot study to test the implementation of Core Entrustable Professional Activities for Entering Residency. The guidelines released earlier this year by the Association of American Medical Colleges are intended to bridge the gap between medical school requirements and the patient care activities new physicians should be able to perform on day one of residency.

The 13 guidelines are the first formal outline of the activities that every graduating medical student should be able to perform upon entering residency regardless of specialty. They include skills such as prioritizing differential diagnoses, recommending tests and collaborating as a member of an interprofessional team, with the ultimate goal of standardizing expectations for both learners and teachers and better preparing students for their roles as clinicians.

“We want to hold schools accountable for producing graduates who are able to perform these skills by the time they graduate as opposed to having to learn them while they’re taking care of patients,” Ryan said, adding that improving patient safety and quality care is the No. 1 objective of the guidelines.

More than 70 medical schools across the country applied to participate in the program and VCU was chosen as one of 10 test sites. Among the other sites are Columbia University College of Physicians and Surgeons, New York University School of Medicine and Yale School of Medicine.

As site lead, Ryan will work with three other School of Medicine faculty members to pilot curriculum and assessment standards that integrate the guidelines. Ten other faculty members who specialize in areas that included patient safety and interprofessional education will offer suggestions as well.

Over the next five years, the faculty members will test the new curriculum to learn what works and develop best practices that other schools can use. The ideal implementation will give students many opportunities to practice with repeated, low-stakes formative assessments, culminating in entrustment decisions for each of the 13 EPAs by the time they graduate.

“This is a game changer,” Ryan said. “The way we used to define a competent doctor was one who’s completed a certain number of years of training. For the past several decades, we’ve moved away from the notion of time and have shifted toward a competency-based mindset. With the development of the Core EPAs, we may finally have the means to assess competency.”


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