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T1 - great question! I think there’s a good case to be made to start undifferentiated, but make the end of med school an internship prep, specific to specialty. #MedEd
T1 #meded Very true. But don't you think with so much emphasis on the senior year being a prep year for residency more emphasis is placed on specialization...not undifferentiation?
Yes in that we all need skills to communicate well, work together, professionally, on teams, in systems, safely, learning, improving, in service of others... #meded
T1: The basic med school education should still be broad. There truly are students who don’t decide what field they want to continue training in sometimes until just before ERAS is due! For early deciders, there are some options like @nyulangone 3yr #MedEd
That's a great question - I think that we really underuse the fourth year. If we are going for residency prep, then we need to look at the outcomes for residents that our learners are having trouble meeting OR the things they need to do on Day 1 that we aren't doing. #MedEd
T1 #meded But will the program directors accept the assessments of the medical school so interns aren't starting all over again? This is an argument about why #CEPAER aren't effective. @acgme
In reply to
@andrewolsonmd, @GLBDallaghan, @MedEdChat, @acgme
Probably not in present form, because there is a disconnect when assessments = grades = match. If we have holistic assessments that are valid and reliable, then yes. #meded
In reply to
@Alliance4ClinEd, @GLBDallaghan, @MedEdChat, @acgme
T1 - totally. And those forces have no reason to change. But if you look at the #EPAC pilot that's a model where assessment = growth not grades!
#meded
In reply to
@GLBDallaghan, @Alliance4ClinEd, @MedEdChat, @acgme
How about move up the start of clerkships. #MakeUSMLEPassFail and take it after clerkships. Then reflect, choose specialty. Then specific course of training (including relevant basic science) needed for starting internship in a specific field. #MedEd
T1 #meded But will the program directors accept the assessments of the medical school so interns aren't starting all over again? This is an argument about why #CEPAER aren't effective. @acgme
In reply to
@andrewolsonmd, @GLBDallaghan, @MedEdChat, @acgme
Is that reasonable (within specialities) that the outcome the UME must meet is different depending on the GME program? Totally agree it is the state of things, but wonder if it should be? #meded
In reply to
@paladineh, @Alliance4ClinEd, @GLBDallaghan, @MedEdChat, @acgme
@harvardmed revamped curriculum this way and 2nd years on wards anecdotally do just as well as prior 3rd years; more time to choose specialty afterwards, explore relevant basic science classes, do research, unclear if ultimate choice happens more thoughtfully though #MedEd
Is that reasonable (within specialities) that the outcome the UME must meet is different depending on the GME program? Totally agree it is the state of things, but wonder if it should be? #meded
In reply to
@paladineh, @Alliance4ClinEd, @GLBDallaghan, @MedEdChat, @acgme
That might take pressure off of us basic scientist to cram everything in, rather tailor it. There is essential content. But also much of detail (for gross #anatomy) could also be put elsewhere. We use the USMLE as our guide 🤷 #meded
T2 #meded It seems that early differentiators would benefit more than later students. With the way the Match is it almost feels that late differentiators would somehow be disadvantaged. Just an observation....
So people are missing the point here (go back to original tweet) that is should be possible on rotations to do BOTH out and inpatient management on any rotation, off service or not. Balance of service and education. #meded
Lots of Step 1 blame and I don’t necessarily disagree, but perhaps it’s the way it’s used; regardless of curricula give GME better data and more time so that they aren’t forced to set arbitrary cutoffs on Step 1
A2: See previous tweet by @yunxuemd@ColumbiaPS also moved to a 1.5 year preclinical curriculum, 1 year of clerkship, & then 1.5 years at the end for finalizing specialty choice, research, many electives & some shared experiences #meded
T2: A lot of schools are moving to 18m preclinical which gives more time for electives. I think this helps both early and late differentiators (disclaimer: I was part of first class @nyulangone with this system) #MedEd
Cool - I was hoping we’d get here. Now we can talk about fundamental change in the Match...where students graduate & match at different times of year (when they’re ready). #MedEd
T2 #meded Do you really think that will happen? It seems there would be a lot of systemic logistics both nationally and institutionally would make this chaotic.
Strong mentorship and sponsorship are so important for the successful residency applicant, regardless of when differentiation happens. Time constraints may lead to "gap years" but the goal would be creating UME that doesn't penalize the late differentiators. #MedEd
Strong mentorship and sponsorship are so important for the successful residency applicant, regardless of when differentiation happens. Time constraints may lead to "gap years" but the goal would be creating UME that doesn't penalize the late differentiators. #MedEd
All barriers to this are logistic - it is probably the right way to proceed from an education standpoint. But there's probably a happy medium somehow. But the universal match is a hindrance. #MedEd
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@mmteacherdoc, @GLBDallaghan, @MedEdChat
Great to see you here @LHortonGI providing the IM perspective!! So crucial to note as medicine is what preclinical years prepare us for the most anyway. If variability still seen, still lots of progress to be made in UME! #MedEd
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@LHortonGI, @MedEdChat, @mmteacherdoc, @harvardmed, @LHortonGI
T2 - now that's a cool idea. There is a rolling process based on competence and the #GME program's needs. But there'd have to be a lot more trust on both sides and transmission of holistic and accurate evaluation data. #meded
In reply to
@GLBDallaghan, @mmteacherdoc, @MedEdChat
This would go along with the milestones discussion in residency. If learners are coming in at different times & with different levels of experience, residency should be different lengths for different learners #meded
In reply to
@GLBDallaghan, @andrewolsonmd, @mmteacherdoc, @MedEdChat
T1 #meded; mostly lurker to these chats, can’t help but chime in tonight. Veterinary schools already provide a good model; same core basic science foundation, then track in years 3-4. Human and vet med schools could learn a lot from one another.
If we really move to #CBME then there is a chance to make a real continuum of education. I wonder at what point we think that UME and GME (if time flexible) occur at one #meded institution? That's why EPAC works here.
In reply to
@paladineh, @GLBDallaghan, @mmteacherdoc, @MedEdChat
They could be taking additional time to learn, and/or to heal, to care for a family member, to mature, to legislate/advocate, to foster world peace... #meded
T3 #meded If honesty and transparency are our goals, a truthful assessment of knowledge, skills, and attitudes could be developed to pass on to programs. Maybe no more grades of any kind.
T3: UME Learner summary of strengths, emphasis, areas to grow across all competencies, including systems. GME programs ready to flex to needs of each intern with patients as focus. #MedEd
T3 - yes!! and #makeusmlestep1passfail. If we go to not grades but have step 1, it becomes the most used and most harmful educational screening test ever. #MedEd
Great choice! And here are the specific areas where this individual has strengths and here are the areas where this individual needs more... in order to gain further independence. #meded
T3: Knowledge and procedural skills can always improve. Professionalism, compassion, diligence, enthusiasm, resilience, etc. are the backbone of motivation towards lifelong learning. Intern on day 1 with the right attitude = successful UME. #MedEd
T3: Doing a rigorous sub-I and a NICU month as MS4 were probably the best prep for me. We did a 1 week “boot camp” at the end of MS4 but it was very general so not as helpful as specialty-specific ones would be. Orientation we went over things like handoffs, note writing #MedEd
This is so very important. Especially since UME would be certifying competence at the level of a starting intern. And advocating for students. Then after match, the “real” MSPE would come with honest objective strengths and opportunities for improvement. #MedEd
Continued ... are sure of their field upon medical school matriculation, we could consider medical schools that only produce certain types of doctors. Or, we could bind residency with medical school for a straight through shot. #familymedicineisawesome#MedEd
A1: yes, as a family medicine physician who provides care for underserved in South Florida, we pluripotent stem cell graduates who can be any type of physician. I would love more primary care docs. Our patients need it. We need it. If students, however, ......
T3 #meded No grades, only formative assessment would be ideal, but in their absence #CBME needs to be made more reliable. Multi-school studies and AMA initiatives will be crucial to standardize enough for residencies to trust and use CBME results.
T3: Hm, think I misinterpreted the question 😅 Comments from rotations are definitely more illustrative than a test score or even clerkship grades (which may vary a lot on shelf exam scores or have preset quotas like 25% honors, 25% near honors...) #MedEd
My Ed Dean asked me if I could "guarantee"our learners would be competent in a certain task after a course. I realized that's the question we have to wrestle with. UME has to be transparent and honest without harming our learners - no good way to do that with the match. #meded
T3 #meded Ideally, the learning should also contribute to that handoff: Here's what I still need to learn, here's what I'm skilled in so far. #CBME will provide a framework, but we can leverage it for reflection and growth.
Working in the ED, but love this topic. @helenjkmorgan has done great work on this. Milestone Based Medical Student Performance Evaluation or mMSPE. We are piloting here @OhioStateMed
In reply to
@Alliance4ClinEd, @helenjkmorgan, @OhioStateMed
And GME hospitals would need to provide more patient care support so that residency programs could function with learners coming in at different times/different levels. I know some already do, but it’s not universal #meded
T3 #meded Definitely! The student will be hugely valuable to the handoff process. That said, evidence on poor self-assessment suggests that portfolio coaches or some such supervised/accountable reflection may be more robust and productive.
I think I know what you’re saying...but I would say more “administrative” and non-physician work” support is what’s needed. Get our residents back to the bedside in #MedEd
In reply to
@paladineh, @GLBDallaghan, @StephRStarr
Feedback and coaching is so important, a huge topic for another night. Lack thereof throughout UME may be the root cause of grads who aren't meeting expectations. #MedEd
In reply to
@mmteacherdoc, @andrewolsonmd, @GLBDallaghan, @StephRStarr
Such a rich discussion and we have to engage @acgme and folks like @boedudley in this work (as they are doing and leading). Structural barriers exist but baby steps will help break them down. #MedEd
Different residencies also have varying opportunity for specific competencies. I was surprised to find out some #pediatricians went through all of residency without ever changing a Gtube or trach, but I was very comfortable with those skills from training @ChildrensLA#MedEd
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@Alliance4ClinEd, @Kind4Kids, @ChildrensLA
#meded Final thoughts.....it seems that educating for undifferentiated physicians is still a need for #meded There is a lot of work to do to truly become the #CBME people we profess to be
True - but with our imagined quarterly match.... #meded.
Please note that it's not the best idea for us in Minnesota to try to match people here in February.....
In reply to
@mmteacherdoc, @DrNickKman, @Alliance4ClinEd
