What training is needed in the fourth year of medical school? Views of residency program directors.
OBJECTIVE
To identify common struggles of interns, determine residency program directors' (PDs') views of the competencies to be gained in the fourth year of medical school, and apply this information to formulate goals of curricular reform and student advising.


METHODS
In 2007, semistructured interviews were conducted with 30 PDs in the 10 most common specialty choices of students at the University of California, San Francisco, School of Medicine to assess the PDs' priorities for knowledge, skills, and attitudes to be acquired in the fourth year. Interviews were coded to identify major themes.


RESULTS
Common struggles of interns were lack of self-reflection and improvement, poor organizational skills, underdeveloped professionalism, and lack of medical knowledge. The Accreditation Council for Graduate Medical Education competencies of patient care, practice-based learning and improvement, interpersonal and communication skills, and professionalism were deemed fundamental to fourth-year students' development. Rotations recommended across specialties were a subinternship in a student's future field and in internal medicine (IM), rotations in an IM subspecialty, critical care, and emergency and ambulatory medicine. PDs encouraged minimizing additional time spent in the student's future field. Suggested coursework included an intensively coached transitional subinternship and courses to improve students' medical knowledge.


CONCLUSIONS
PDs deemed the fourth year to have a critical role in the curriculum. There was consensus about expected fourth-year competencies and the common clinical experiences that best prepare students for residency training. These findings support using the fourth year to transition students to graduate medical training and highlight areas for curricular innovation.
Lyss-Lerman
Pamela
P
University of California, San Francisco, San Francisco, California, USA.
Teherani
Arianne
A
Aagaard
Eva
E
Loeser
Helen
H
Cooke
Molly
M
Harper
G Michael
GM
D001291:Attitude of Health Personnel; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence / Q000592:standards; D003479:Curriculum / Q000592:standards; D004501:Education, Medical; D004503:Education, Medical, Graduate / Q000458:organization & administration; D004526:Efficiency; D005180:Faculty, Medical; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008611:Mentors; D017145:Models, Educational; D008486:Physician Executives; D010819:Physician's Role; D018794:Problem-Based Learning / Q000458:organization & administration; D013038:Specialization