Milestones for Internal Medicine Sub-interns.
BACKGROUND
As residency programs move toward measuring milestones for competency-based education assessment, medical schools will need to collaborate with residencies to determine competencies for graduating students. The objective of this study is to define the educational milestones for fourth-year medical students during an Internal Medicine sub-internship.


METHODS
A cross-sectional Internet-based survey (with attention to validity evidence) was developed in early 2013 and administered to Internal Medicine attendings and Internal Medicine sub-interns working on an inpatient team at 3 academic medical centers. With the purpose to determine the milestones for sub-interns, items asked respondents what responsibilities a sub-intern could be entrusted to perform without direct supervision.


RESULTS
Faculty responded that behaviors sub-interns could perform with indirect supervision were mostly at the "reporter" level, including completing a history and physical examination and collecting data such as test results. Other skills such as venipuncture and some communication skills such as calling consults, providing patient counseling, responding to pages, and creating discharge instructions were examples of tasks in which the majority of faculty felt that students were progressing toward unsupervised practice. Behaviors where the majority of faculty would always supervise a medical student performance included performance on the "interpreter" level, including interpreting electrocardiograms, significant physical examination findings, and laboratory results. Medical students less commonly noted needing supervision on the majority of the items when compared with faculty.


CONCLUSIONS
Tasks in the reporter domain such as taking a history, collecting medical records, and reporting results can be characterized as medical student milestones.
Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor; Department of Medical Education, University of Michigan Medical School, Ann Arbor. Electronic address: ssanten@umich.edu.
Sally A
SA
Santen
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Internal Medicine, Duke University School of Medicine, Durham, NC.
Jessica L
JL
Seidelman
Department of Medicine, Tulane University School of Medicine, New Orleans, La.
Chad S
CS
Miller
Department of Internal Medicine, Emory University School of Medicine, Atlanta, Ga.
Erica D
ED
Brownfield
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
Nathan
N
Houchens
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
Thomas H
TH
Sisson
Department of Medical Education, University of Michigan Medical School, Ann Arbor; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
Monica L
ML
Lypson
D016009:Chi-Square Distribution; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D015203:Reproducibility of Results; D012577:Schools, Medical / Q000458:organization & administration; D013337:Students, Medical / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
Assessment; Medical education; Medical student; Milestones; Resident