Across the country, fresh-faced medical students are arriving at hospitals this month, ready to start their residency training. And for the first time, one group says it’s compiled a list of duties that every new doctor should be able to perform on the first day, regardless of his or her specialty.
Earlier this year, the Association of American Medical Colleges released a new guide, highlighting 13 skills that every hospital should expect their residents to be able to perform from the start. Those include skills that aren’t always taught in medical school — which are, nonetheless, critical in today’s evolving health care environment — such as collaborating as a member of an interprofessional team and identifying system failures, says Robert Englander, M.D., senior director of competency-based learning and assessment.
The association first embarked on this process early last year, he tells me, after hearing concerns that there’s a gap between what’s expected of residents and how they actually perform in the field.
"That’s really why we went after this — to try and clearly state what the expectations are, and then to figure out, over the next several years, how we get all of the students to that point of entrustment on these 13 activities," Englander says.
Improving patient safety was a key driver in formulating the list, the AAMC highlighted in an announcement last month, ahead of the start of residency programs in July. Every student now entering your hospital should be able to:
- Gather a history and perform a physical examination.
- Prioritize a differential diagnosis following a clinical encounter.
- Recommend and interpret common diagnostic and screening tests.
- Enter and discuss orders and prescriptions.
- Document a clinical encounter in the patient record.
- Provide an oral presentation of a clinical encounter.
- Form clinical questions and retrieve evidence to advance patient care.
- Give or receive a patient handover to transition care responsibility.
- Collaborate as a member of an interprofessional team.
- Recognize a patient who requires urgent or emergent care and initiate evaluation and management.
- Obtain informed consent for tests and procedures.
- Perform general procedures of a physician.
- Identify system failures and contribute to a culture of safety and improvement.
Englander says that the association now plans to start asking residency program directors how well prepared for these duties their residents were on their first days. Eventually, they’ll establish a baseline measure, and follow it over the years as hospitals and other care sites implement the guidelines. The association is also working with five medical schools to work backward, he says, developing curricula that prepares students for residency. Many med schools and specialty programs already have their own specific graduation requirements. But the AAMC hopes their guide finally provides a definitive list that applies to every newly minted M.D.
For hospital leaders, this is a chance to mold the doctors-in-training who will eventually shape the future of health care, Englander says.
"For the CEOs and the hospital folks who run most of these residency programs, this is an exciting opportunity for them," he says. "Our goal, ultimately, is to produce entering residents who are better prepared to do the tasks or activities of residency, without direct supervision. To me, that’s the major takeaway."