Evaluation of a national curriculum reform effort for the medicine core clerkship

BACKGROUND: In 1995, the Society of General Internal Medicine (SGIM) and th e Clerkship Directors in Internal Medicine (CDIM) developed and disseminate d a new model curriculum for the medicine core clerkship that was designed to enhance learning of generalist competencies and increase interest in gen eral internal medicine. OBJECTIVE: To evaluate the dissemination and use of the resulting SGIM/CDIM Core Medicine Clerkship Curriculum Guide. DESIGN: Survey of internal medicine clerkship directors at the 125 medical schools in the United States. MEASUREMENTS AND MAIN RESULTS: The questionnaire elicited information about the use and usefulness of the Guide and each of its components, barriers t o effective use of the Guide, and outcomes associated with use of the Guide . Responses were received from 95 clerkship directors, representing 88 (70% ) of the 125 medical schools. Eighty-seven (92%) of the 95 respondents were familiar with the Guide, and 80 respondents had used it. The 4 components used most frequently were the basic generalist competencies (used by 83% of those familiar with the Guide), learning objectives for these competencies (used by 83%), learning objectives for training problems (used by 70%), an d specific training problems (used by 67%); 74% to 85% of those using these components found them moderately or very useful. The most frequently ident ified barriers to use of the Guide were insufficient faculty time, insuffic ient number of ambulatory care preceptors and training sites, and need for more faculty development. About 30% or more of those familiar with the Guid e reported that use of the Guide was associated with improved ability to me et clerkship accreditation criteria, improved performance of students on th e clerkship exam, and increased clerkship time devoted to ambulatory care. CONCLUSION: This federally supported initiative that engaged the collaborat ive efforts of the SGIM and the CDIM was successful in facilitating signifi cant changes in the medicine core clerkship across the United States.