2. M4 Interest Group- 2014 Nabil Issa, MD- Director, Surgery Subinternship Northwestern University Feinberg School of Medicine

3. 1.The professional continuum & surgical sub-I 2.The sub-I in literature 3.Position paper- recommendation threads What we’ll talk about

4. The Professional Continuum & Surgical Subinternship

5. AAMC: Entrustable Professional Activities (EPA) M1-2 M3 Residents M4

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: I.ACS/APDS/ASE National Preparatory Surgery Curriculum II.Medical student subinternships in surgery: characterization and needs assessment

8. ACS/APDS/ASE National Preparatory Surgery Curriculum  Needs Assessment- Main findings: 1.Anxiety /deficient technical skills 2.Managing multiple simultaneous demands 3.Managing critical/unstable patients 4.Management of Post-op conditions 5.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! 1.Formal objectives. 2.Reading list. 3.Review common call problems. 4.Procedures laboratory. 5.Dedicated time with faculty. 6.Direct responsibility. 7.Autonomy.

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

14. Conceptual Framework M1-2 M3 Residents M4 AAMC: EPA M3 National Curriculum ACS/APDS/ASE Boot Camp

15. AAMC: Entrustable Professional Activities (EPA) M1-2 M3 Residents M4

16. Recommendation Threads 1.Administrative Structure 2.Goals and Objectives 3.Curricular elements 4.Instructional strategies 5.Assessment tools 6.Clerkship evaluation

17. Administrative Structure M3 ≠ M4

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

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

20. Administrative Structure M3 ≠ M4 M3/M4 Director Coordinator

21. Role of Sub-I Director 1.Create curriculum: M3 → Residency 2.Explicit goals & objectives 3.Comprehensive orientation 4.Choice of clinical rotations 5.Petition school for resources 6.Protected educational time 7.Career coach

22. Role of Sub-I Coordinator 1.Coordinating educational activities 2.Administrative link to school and department policies, rules and announcements 3.Documentation: student and rotation activities 4.Weekly follow up e-mails to enforce task completion 5.Administrative timelines

23. Curricular Elements

24. Goals and Objectives 1.H&P skills: Concise & pertinent. 2.Clear progress notes. 3.Advanced clinical reasoning. 4.Manage common surgical problems. 5.Perform common bedside procedures. 6.Patient handoffs during transitions of care. 7.Professional communications. 8.Utilize informatics.

25. Instructional Strategies 1.Direct observations: H&P/DDx/management plans 2.Professor rounds: case-based discussions 3.Mock pages: common problems 4.Web-based modules: SBAR/Handoffs 5.Technical skills lab: common bedside procedures 6.Independent reading: pt. safety/quality controls/ evidence-based medicine 7.End of rotation project or assay.

26. Assessment Tools Composite Scoring: 1.Appraisals of clinical performance 2.Performance on mock pages 3.Participation in discussion during Prof. rounds 4.Procedural competence 5.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 M1-2 M3 Residents M4 AAMC: EPA M3 National Curriculum ACS/APDS/ASE BootCamp

30. QUESTIONS