NATIONAL SURVEY OF CLERKSHIP DIRECTORS IN INTERNAL-MEDICINE ON THE COMPETENCES THAT SHOULD BE ADDRESSED IN THE MEDICINE CORE CLERKSHIP

PURPOSE: TO prioritize competencies that should be addressed in the me dicine core clerkship, assess factors influencing this prioritization, and estimate the percentage of clerkship time that should be devoted to inpatient versus outpatient care. METHODS: A national survey of the Clerkship Directors in Internal Medicine (CDIM) was used. Using expli cit criteria, respondents assigned priority scores, on a 1 to 5 scale, to 17 general competencies and 60 disease-specific clinical competenc ies pertinent to care of adult patients in inpatient. ambulatory, inte nsive care, and emergency settings. RESULTS: Ninety-three (75%) of 124 CDIM members responded. The highest mean priority scores were assigne d to 6 general competencies: case presentation skills (4.65), diagnost ic decision-making (4.64), history and physical diagnosis (4.61), test interpretation (4.47), communication with patients (4.35), and therap eutic decision-making (4.12). Disease-specific clinical competency are as receiving the highest mean priority scores were: hypertension (4.57 ), coronary disease (4.53), diabetes mellitus (4.45), heart failure (4 .42), pneumonia (4.39), chronic obstructive pulmonary disease (4.26), acid-base/electrolyte disorders (4.19), and acute chest pain (4.08). P riorities for general competencies were moderately correlated with imp ortance to the practice of general internists (mean Spearman rho 0.49) and with importance to students pursuing careers outside internal med icine (mean Spearman rho 0.45), but only weakly correlated with the ad equacy with which a competency was addressed in other parts of the cur riculum. Respondents' mean recommended allocation of clerkship time wa s: 52% inpatient, 33% ambulatory care, 8% intensive care, and 7% emerg ency medicine. This time allocation did not differ by any characterist ics of respondents. CONCLUSION: There is consensus among medicine cler kship directors that the medicine core clerkship should emphasize fund amental competencies and devote at least one third of the time to clin ical competencies pertinent to ambulatory care. (C) 1997 by Excerpta M edicine, Inc.