Reforming the core clerkship in internal medicine: The SGIM/CDIM project

Dramatic changes in health care have stimulated reform of undergraduate med ical education. In an effort to improve the teaching of generalist competen cies and encourage learning in the outpatient setting, the Society of Gener al Internal Medicine joined with the Clerkship Directors in Internal Medici ne in a federally sponsored initiative to develop a new curriculum for the internal medicine core clerkship. Using a broad-based advisory committee an d working closely with key stakeholders (especially clerkship directors), t he project collaborators helped forge a new national consensus on the leami ng agenda for the clerkship (a prioritized set of basic generalist competen cies) and on the proportion of time that should be devoted to outpatient ca re (at least one third of the clerkship). From this consensus emerged a new curricular model that served as the basis for production of a curriculum g uide and faculty resource package. The guide features the prioritized set o f basic generalist competencies and specifies the requisite knowledge, skil ls, and attitudes/values needed to master them, as well as a list of sugges ted training problems. it also includes recommended training experiences, s chedules, and approaches to faculty development, precepting, and student ev aluation. Demand for the guide has been strong and led to production of a second edit ion, which includes additional materials, an electronic version, and a pock et guide for students and faculty. A follow-up survey of clerkship director s administered soon after completion of the first edition revealed widespre ad use of the curricular guide but also important barriers to full implemen tation of the new curriculum, Although this collaborative effort appears to have initiated clerkship reform, long-term success will require an enhance d educational infrastructure to support teaching in the outpatient setting.