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Background: Medical educators grapple with predicting performance of graduates identified as struggling during medical school. Students appear before student promotions committees (SPCs) for multiple cognitive and noncognitive reasons and performance outcomes for this cohort have not been well defined in the literature. Purpose: To determine the predictive validity of SPC appearance with respect to performance on a Program Director's (PD's) Evaluation Form completed at the end of internship (PGY-1). Method: Residents were classified as 'below average,' 'average,' or 'above average' based on PD Evaluation Form ratings. This PD instrument has been shown to be feasible, reliable, and valid. Below-average residents were defined as having a below-average rating on any question on the PD Evaluation Form. We compared SPC and non-SPC cohorts with respect to these PD Evaluation Form ratings. The t test was used for statistical analysis. Results: Seven years of graduating classes from our institution were included. Of students who graduated from our institution, 119 of 856 students (14%) were presented at our SPC during medical school during our study period. There were 196 residents (23%) identified as below average. The PD Evaluation Form response rate for this period was 77%. Students who appeared at our SPC were significantly more likely to have below-average scores for almost all PD Evaluation Form questions with small to moderate effect sizes. Conclusions: Students who appear before SPCs are at higher risk of below-average performance as rated by a PD Evaluation Form at the end of PGY-1. However, only a minority of trainees that appeared before our SPC received below-average ratings during internship. These data provide predictive validity evidence that SPC appearance during medical school does identify below average performance during internship. Our data support that SPC appearance during medical school, regardless of cause, is a risk for below average performance during internship. [ABSTRACT FROM AUTHOR]

Background: Shortages in primary care careers such as internal medicine are projected in the future. Conducting research is an explicit requirement for graduate medical education and interest in research is growing in undergraduate medical education. Purpose: We hypothesized that a medical student research initiative could increase student research productivity and foster mentoring relationships with internists. Method: We compared the number of medical student presentations, awards, and peer-reviewed publications before and after a brief research initiative at a single institution and recorded comments from student participants; data collected before the initiative were retrospective, and data after the initiative were collected prospectively. Mann-Whitney U was used for statistical analysis. Results: Twenty-seven students participated in our workshop initiative during the study period (2000-2005). Eighteen (67%) subsequently had presentations, research awards, and/or publications during the study period. Mann-Whitney U testing of groups (all pre-initiative Uniformed Services University students and initiative participants) showed a statistically significant increase in regional presentations (p = .003), research awards (p = .01), and publications (p = .02) after the research initiative. Student comments not only revealed research mentoring benefits but also commented on receiving career counseling advice from mentors. Conclusions: Our study findings support the feasibility of this initiative as well as produced significant outcomes in terms of quantified research productivity and student mentoring. [ABSTRACT FROM AUTHOR]

Background: The 4th-year internal medicine subinternship (subI), with its strong emphasis on experience-based learning and increased patient responsibilities, is an important component of undergraduate medical education. Discussions have begun amongst educational leaders on the importance of standardizing curriculum and evaluation tools utilized during the subinternship. Purpose: The objective of this survey was to describe the current state of educational practices regarding the subI curriculum, use of Clerkship Directors in Internal Medicine (CDIM) curricular guidelines, evaluation methodologies, and subintern call frequency and duty hours. Methods: The survey was a part of the CDIM annual survey sent to 109 institutional members in 2005. The subinternship survey included 17 questions that addressed the prevalence of formal curricula in the subinternship, use of CDIM curricular guidelines and resources, and the evaluation tools utilized for assessment of the subinternship. Two questions examined the call frequency and duty hours of the subinterns. Results: Eighty-eight members responded (81%). Of the respondents, 37% have a formal curriculum and 35% used CDIM curricular guidelines for the subinternship. More than half of the respondents agreed that the curricular guide helped organize their subI rotations (53%), and 48% agreed that it enhanced the quality of subI education. A global rating summative evaluation form (56%) was the most commonly used evaluation tool in the subinternship. Objective Structured Clinical Examinations1-3 (1%) and Mini-Clinical Evaluation Exercise (mini-CEX)4(2%) were much less utilized during the subinternship. The respondents expressed an interest in the development of a standardized exam (47%) and clinical assessment tools such as the mini-CEX (59%). The vast majority of IM subinterns participate in 3 to 9 calls per rotation and spend less than 80 hr in the hospital per week. Conclusions: A formal curriculum is offered in slightly more than one third of subIs. Clerkship directors expressed interest in developing standardized evaluation tools to assess subintern competencies. The majority of IM subinterns spend less than 80 hr in the hospital per week. Further studies are needed to assess barriers to incorporating a formal curriculum and develop standardized tools to assess subintern competencies. [ABSTRACT FROM AUTHOR]

Background: Despite published literature demonstrating deficiencies in chest radiograph (CXR)/basic radiology interpretation skills of 4th-year medical students, studies and subsequent curricula regarding the training needed to obtain these skills are lacking. Terms such as clinical exposure and radiology teaching have been used to describe the experience for these basic interpretive skills, but best practice methods of delivery, let alone common methods, have yet to be defined. Purpose: The objective is to describe the current methods of teaching and assessing CXR/basic radiology interpretation skills across institutions on the 3rd-year internal medicine (IM) clerkship. Methods: In 2005, the Clerkship Directors in Internal Medicine (CDIM), an international organization representing U.S. and Canadian medical schools, surveyed its institutional members. Twelve questions on the survey dealt with X-ray interpretation. Results: Eighty-eight of 109 members (81%) responded to the survey. Overall, 81% of respondents felt that CXR interpretation is an important clinical skill for medical students. Seventy-six percent indicated that instruction in these skills occurs on the IM clerkship. The most cited methods of instruction were lectures (56%) and teaching rounds (48%). Most schools spent on average of 2 to 4 hr during the IM clerkship on formal radiology instruction. Only 33% indicated that radiology interpretation skills are assessed during the clerkship. The most common assessment methods were written examination (19%) and OSCE (19%). Conclusion: Substantive data regarding attainment and assessment of CXR/basic radiology interpretation skills in the undergraduate curriculum are lacking. Our study provides preliminary descriptive data regarding CXR instruction and assessment on the 3rd-year IM clerkship. [ABSTRACT FROM AUTHOR]

Background: Evaluation methods within and across clerkships are rapidly evolving, including greater emphasis or frameworks for descriptive evaluation and direct observation of competence. Purpose: The purpose of this study is to describe current evaluation methods, use of the Reporter-Interpreter-Manager/Educator (RIME) framework, and grade assignment by internal medicine clerkship directors. Methods: In 2005, the Clerkship Directors in Internal Medicine surveyed its 109 institutional members. Topics included evaluation methods and grade contribution, use of evaluation sessions and/or RIME, and grade assignment (criterion referenced or normative). Results: Response rate was 81% (88/109). The evaluation methods were as follows: teachers' evaluations, 93% (64% of grade); National Board of Medical Examiners subject examination, 81% (25% of grade); faculty written exam, 34% (14% of grade); objective structured clinical examinations, 32% (12% of grade); direct observation, 22% (7% of grade). RIME is used by 42% of respondents. Many clerkship directors (43%) meet with teachers to discuss student performance. Criterion-referenced grading is used by 59%, and normative grading is used by 27%. Unsatisfactory grades are given for examination failures (72%), unprofessional behavior (49%), poor clinical performance (42%), and failure to meet requirements (18%). Conclusions: Internal medicine clerkship directors emphasize description and observation of students. RIME and discussions with teachers are becoming commonplace. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the feasibility and construct validity of our graduate and employer survey and its potential use in programmatic evaluation. Methods: An identical survey instrument was sent to fellowship graduates from our institution and their employers. We estimated feasibility through determining our survey response rate. Construct validity was assessed by comparing graduate self-ratings and employer ratings and through comparing survey ratings with passing board-certification examinations and referrals to the National Practitioner Databank. Results: Eleven years of graduates were included (n = 38 graduates). Response rates were 84% and 82% for graduates and their employers, respectively. Mean supervisor ratings were greater than graduate self-ratings on all questions. The lowest rating consistently across survey years was in graduates' self-perception of their ability to direct a PFT lab. One fellow failed his pulmonary boards and 1 failed his critical care boards on the first attempt. No graduates were referred to the National Practitioner Databank during our study period. Conclusions: This fellowship survey appears to be feasible and have construct validity. The consistency in the relatively low self-rating of graduates in directing a PFT lab has led to important areas for curriculum reform. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine how well published expectations are being met for internal medicine (IM) clerkship directors (CDs). Method: In 2005, the Clerkship Directors in Internal Medicine (CDIM) surveyed its institutional members. One section addressed expectations, in terms of requirements and resources, of and for CDs. Survey questions were categorical (yes, no, or unsure) addressing the essential responsibilities and resources outlined in the Alliance for Clinical Education (ACE) consensus statement. Descriptive statistics, MannWhitney U, and chi-square testing were used for inferential statistical procedures. Results: Eighty-eight of 109 institutional members responded to the survey (81% response rate). For each responsibility, more than 90% of respondents reported that they were required to meet the expectation; however, for each of the 8 essential resources, the percentage of respondents who were meeting the expectation varied from 41% for additional time and resources for administering other courses to 95% for sufficient material resources to support clerkship requirements. With the exception of larger institutions having greater access to new technology (p = .038, MannWhitney U) and a defined budget (p = .012, MannWhitney U), there were no differences in demographics between respondents who did and did not meet expectations or resources. Conclusion: IM CDs reported that they are expected to achieve essential responsibility benchmarks. Essential resources were being met in a variable fashion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Step 2 Clinical Skills (CS) was recently introduced into the United States Medical Licensing Examination (USMLE) to ensure that successful candidates for licensure possess the clinical skills to provide safe and effective patient care. AIMS: To explore if medical schools had changed the objectives, content, or emphasis in their pre-clinical curriculum in response to its implementation. METHODS: In April 2005, the Clerkship Directors in Internal Medicine (CDIM) sent an electronic survey to a single member from each medical school with a CDIM member. The survey instrument included 26 pre-clinical curricular questions with nine questions specifically addressing changes in response to implementation of the Step 2 CS. RESULTS: Forty-five percent of respondents reported changes to the Introduction to Clinical Medicine (ICM) course objectives while 39% and 40% reported changes in content and emphasis. Seventy-four percent felt their students were adequately prepared for the Step 2 CS and 18% were unsure. CONCLUSIONS: Over a third of medical schools are implementing changes to the objectives, content, and/or emphasis of their curriculum, at least partially in response to the institution of Step 2 CS. [ABSTRACT FROM AUTHOR]