AAMC Table 92 Residency Readiness in the 4th Year of Medical School: Using ACGME Milestones to Assess & Prepare Medical Students for Residency In many cases, the fourth year of medical school continues to be a lost opportunity for learning. The popularity of boot camps with an emphasis on the student’s specialty of choice continues to grow. At several institutions, the fourth year is designed to use specialty-specific milestones to improve the transition to residency. The senior year should be more robust with consideration for student assessment for selected ACGME milestones expected of an incoming resident in their designated specialty.

1. Learn Serve Lead 2018
The AAMC Annual Meeting Focused DiscussionsWith Lunch
Saturday, November 3, 11:45 a.m.-1:15 p.m.
Table Host: Nicholas Kman,The Ohio State University College of Medicine
Nicholas.kman@osumc.edu, twitter: @drnickkman
92 Residency Readiness in the Fourth Year of Medical School: Using ACGME Milestones to
Assess and Prepare Medical Students for Residency
In manycases,the fourthyear of medical school continuestobe alost opportunityforlearning.The
popularityof bootcampswithan emphasisonthe student’sspecialtyof choice continuestogrow.At
several institutions, the fourthyearisdesignedtouse specialty-specificmilestonestoimprove the
transitiontoresidency.The senioryearshouldbe more robustwithconsiderationforstudent
assessmentforselectedACGMEmilestonesexpectedof anincomingresidentintheirdesignated
specialty.
The Post ClerkshipCurriculum10
:
1. Intensive clinical course worktakenduring4thyearassociatedwithenhancedexcellent
performance indomainsof medical knowledge,patientcare,andpractice basedlearning.
2. # of intensive courses=subinternships,intensive care,surgical clerkships,&EMrotations.
3. Increasedexposuretointensive clinical course workduring4thyearwasassociatedwithbetter
clinical evaluationsduringinternship.
Boot Camps, MilestonesandClinical Tracks5,6
:
1. Frameworkfor4th year that alignsUME and GME such that the studentisworkingtowardentry
level milestones(ACGMEmilestones) toprepare themforinternyearinspecialtyof choice.
2. Composedof a conglomerationof experiences(requiredcourses,electives,bootcamps) the
studenthasduring4th year to prepare themforinternship.
3. For example,inthe EMclerkship:Clinical Performance Assessment(CPA) providedaglobal
assessmentof patientcare Milestonesbasedonend-of-shiftperformance evaluationsgathered
fromnumerousfacultyoverthe course of the mandatory4-weekclerkship.
4. EM clerkshipEPA 10 simulationassessmentprovidedastandardizedmeasure of astudent’s
managementof the emergentpatientinasimulatedemergencydepartmentsetting.
5. EM clerkshipprocedure labassessmentsmeasuredLevel1Milestonesforairwaymanagement,
ultrasound,wound care andvascularaccess.
6. The AmbulatoryClerkshipCritical Appraisal of Topic(CAT) assignmentwasusedtomeasure how
well astudentusedevidence-basedmedicine toappraise aclinical question.
7. A Post-Match,Specialty-Specific,Milestone-basedEducationalHandover(MH) canimprove
ResidencyProgramPerceptionof InternReadiness8,9
.

2. Referencesand Recommended Reading:
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paper: recommendations for redesigning the "finalyear"ofmedicalschool. Teach LearnMed.2014;26(4):420-7. doi:
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2. Chen HC, van den Broek WE, ten CateO. The casefor use ofentrustable professionalactivities inundergraduate medicaleducation. Acad
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3. Elnicki, etalfor theCDIM/AssociationofProgramDirectors in InternalMedicineCommitteeon Transition toInternship. CourseOfferings
in the FourthYear ofMedicalSchool:How U.S.MedicalSchools ArePreparing Students for Internship. Academic Medicine2015.
4. Lyss-Lerman P,TeheraniA, Aagaard E, Loeser H, CookeM, Harper GM. What training is neededin the fourthyear ofmedicalschool?
Views of residency program directors.AcadMed.2009Jul;84(7):823-9.doi: 10.1097/ACM.0b013e3181a82426. PubMed PMID: 19550170.
5. Khan M, Splinter A, Kman NE, Leung C, RundellK, Davis J, McCallister J.Transitionto Residency: Using Specialty-Specific Clinical Tracks and
Advanced Competencies toPrepareMedicalStudents for Internship.MedicalScienceEducator,2017, 1-8.
6. Leung CG, Thompson L,McCallisterJW,Way DP,Kman NE. Promoting Achievement ofLevel 1Milestones for Medical Students Going into
Emergency Medicine. WestJ Emerg Med. 2017 Jan;18(1):20-25.doi: 10.5811/westjem.2016.10.31247.Epub 2016 Dec 5. PubMedPMID:
28116003; PubMedCentralPMCID: PMC5226757.
7. WackettA, Daroowalla F, Lu WH,Chandran L.Reforming the4th-Year Curriculum as a Springboardto GraduateMedicalTraining: One
School's Experiences andLessons Learned.Teach LearnMed.2016;28(2):192-201.doi: 10.1080/10401334.2016.1146610. PubMed PMID:
27064721.
8. Wancata LM, Morgan H, SandhuG, Santen S, Hughes DT. Using the ACMGEMilestones as a HandoverTool From Medical Schoolto
Surgery Residency. J Surg Educ.2017May -Jun;74(3):519-529.doi: 10.1016/j.jsurg.2016.10.016. Epub2016Nov 28. PubMedPMID:
27908638.
9. Sozener CB, Lypson ML, HouseJB, HopsonLR, Dooley-HashSL, HauffS, Eddy M, Fischer JP, Santen SA. Reporting Achievement ofMedical
Student Milestones to Residency Program Directors: An EducationalHandover. AcadMed. 2016 May;91(5):676-84. doi:
10.1097/ACM.0000000000000953. PubMedPMID: 26488570.
10. Richards CJ, Mukamal KJ, DeMelo N, Smith CC. Fourth-Year Medical School Course Load and Success as a MedicalIntern. J Grad
Med Educ. 2017 Feb;9(1):58-63. doi: 10.4300/JGME-D-16-00043.1. PubMed PMID: 28261395; PubMed Central PMCID:
PMC5319629.