Reforming the Core Clerkship in Internal Medicine: The SGIM/CDIM Project

2 January 2001 | Volume 134 Issue 1 | Pages 30-37

Dramatic changes in health care have stimulated reform of undergraduate medical education. In an effort to improve the teaching of generalist competencies and encourage learning in the outpatient setting, the Society of General Internal Medicine joined with the Clerkship Directors in Internal Medicine in a federally sponsored initiative to develop a new curriculum for the internal medicine core clerkship. Using a broad-based advisory committee and working closely with key stakeholders (especially clerkship directors), the project collaborators helped forge a new national consensus on the learning agenda for the clerkship (a prioritized set of basic generalist competencies) and on the proportion of time that should be devoted to outpatient care (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 guide and faculty resource package. The guide features the prioritized set of basic generalist competencies and specifies the requisite knowledge, skills, and attitudes/values needed to master them, as well as a list of suggested training problems. It also includes recommended training experiences, schedules, and approaches to faculty development, precepting, and student evaluation.

Demand for the guide has been strong and led to production of a second edition, which includes additional materials, an electronic version, and a pocket guide for students and faculty. A follow-up survey of clerkship directors administered soon after completion of the first edition revealed widespread use of the curricular guide but also important barriers to full implementation of the new curriculum. Although this collaborative effort appears to have initiated clerkship reform, long-term success will require an enhanced educational infrastructure to support teaching in the outpatient setting.

Author and Article Information

From Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; The Johns Hopkins School of Medicine, Baltimore, Maryland; Mount Sinai School of Medicine, New York, New York; Washington University School of Medicine, St. Louis, Missouri; and Case Western Reserve University, Cleveland, Ohio.

Acknowledgments: The authors thank Elnora Rhodes of the Society of General Internal Medicine, who administered the project. They also thank Charles Clayton of the Clerkship Directors for Internal Medicine and Ruth Kahn and Diane Harbison, Project Directors, Bureau of Health Manpower/Division of Medicine, for administrative support and encouragement.

Grant Support: By contract 240-93-0029 from the U.S. Department of Health and Human Services, Health Resources & Services Administration.

Requests for Single Reprints: Allan H. Goroll, MD, Massachusetts General Hospital, ACC Suite 645, Boston, MA 02114.

Current Author Addresses: Dr. Goroll: Massachusetts General Hospital, ACC Suite 645, Boston, MA 02114.

Dr. Morrison: University of Pennsylvania, Hamilton Walk, Suite 100 Stemmler, Philadelphia, PA 19104-6087.

Dr. Bass: Johns Hopkins University, 1830 East Monument Street, Room 8068, Baltimore, MD 21205.

Dr. Jablonover: MCP–Hahnemann University, 3300 Henry Avenue, 4th Floor, Philadelphia, PA 19129-1191.

Dr. Blackman: MC 3051, 5841 South Maryland Avenue, Chicago, IL 60637.

Dr. Platt: Mount Sinai Medical Center, Box 1068, New York, NY 10029.

Dr. Whelan: Washington University School of Medicine, 660 South Euclid Avenue, Box 8073, St. Louis, MO 63110.

Dr. Hekelman: Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44122.