An Entrustable Professional Activity (EPA)-Based Framework to Prepare Fourth-Year Medical Students for Internal...

Area of Science:

• Medical Education
• Internal Medicine Residency Training
• Graduate Medical Education

Background:

• The purpose and structure of the fourth year of medical school are debated, causing confusion for students and educators.
• The Association of American Medical Colleges (AAMC) introduced Core Entrustable Professional Activities for Entering Residency (CEPAERs) in 2014.
• Existing frameworks often lack specific guidance for preparing students for internal medicine residency.

Purpose of the Study:

• To propose a curricular framework for the fourth year of medical school focused on residency preparation.
• To identify key Core Entrustable Professional Activities for Entering Residency (CEPAERs) most relevant to internal medicine.
• To provide instructional and assessment strategies for these critical activities.

Main Methods:

• A committee of Internal Medicine Clerkship Directors and Program Directors adapted the AAMC's CEPAERs.
• Stakeholder surveys informed the selection of five most relevant CEPAERs for residency preparation.
• The framework details specific activities and competency assessment methods.

Main Results:

• A framework is proposed based on five critical CEPAERs: entering orders, answering clinical questions, patient handovers, interprofessional collaboration, and urgent care recognition/initiation.
• Suggestions for instruction and assessment are provided for each identified CEPAER.
• The framework aims to standardize and enhance the transition from medical school to residency.

Conclusions:

• Implementing a curriculum based on selected CEPAERs can effectively prepare medical students for internal medicine residency.
• This structured approach enhances the fourth year of medical school, making it more rewarding and productive.
• Well-prepared residents can function more safely and competently in supervised postgraduate settings.