“There’s such a different objective to the Dean’s Letter,” Dr. Morgan said. “The Dean’s Letter is to help the student get into a good residency. What we want to send at the end of medical school is more along the lines of helping the learner succeed once they start their residency.”
How to present evidence of achievement?
The dilemma: Medical students enter into residency as unfinished products, and the challenge for medical schools is to identify where or how the product is unfinished. Once that is identified, it is key for medical schools to indicate how a student measures up and transmit this information to residency institutions in a format that is easy to comprehend. That format needs to go further than measuring students against classmates. It should measure the skills that medical students need to be a physician and offer a pathway to mastery of those skills.
Solution 1: Follow the Core Entrustable Professional Activities for Entering Residency (EPAs).
Published by the Association of American Medical Colleges in 2014, the 13 Core EPAs provide a set of tasks that learners should be able to perform upon entering residency. Rather than focusing on facts and lessons, the EPAs focus on tasks—such as working in an interprofessional team or performing a history and examination—and how a student is progressing toward being able to perform them well without supervision from a faculty member.
George C. Mejicano, MD, is the senior associate dean for education at Oregon Health & Science University (OHSU) and proponent of EPAs as a good way to measure students going into residency. Starting with the class of 2018, after the Match, OHSU plans to send an additional document to residency programs that represents where medical students who are entering residency stand from an EPA perspective.
“Patients don’t care about what a doctor knows,” Dr. Mejicano said. “What they care about is feeling better. The EPA framework gets to that patient and clinical perspective. It gets to tasks that actually matter because they are related to tasks the clinicians actually do.”
Solution 2: Follow the core competencies and specialty-specific milestones set forth by the Accreditation Council for Graduate Medical Education (ACGME).
The six ACGME core competencies describe trainable attributes of an individual that apply to all physicians. The milestones are specialty-specific achievements. In both instances, they are designed to evaluate and track residents. In essence, they are mile markers indicating how much further a trainee has to go. They are also part of an evaluation framework commonly used by residency programs. So if they are applied at the undergraduate medical education level, residency programs are more likely to understand what they mean in relation to a medical student’s progress.
Sally Santen, MD, PhD, is a professor of emergency medicine and assistant dean for educational research and quality improvement at the University of Michigan Medical School. Michigan informs medical schools where students stand on specialty-specific ACGME milestones in a letter sent after the Match.
“Many of the medical schools had been using the competencies to begin with, so it was easy just to continue with that,” Dr. Santen said. “Program directors understood the language. So they understood what they were getting [with the supplemental letter].”
The session on the transition to residency was among dozens that took place during the ChangeMedEd conference. The event showcased how the AMA, through its Accelerating Change in Medical Education initiative, is working to reimagine and shape the future of medical education.