Background: Individualized Learning Plans (ILPs) are standardized forms that allow graduating students to self-identify goals, strengths, and weaknesses prior to starting residency. The Coalition for Physician Accountability has advocated for their use in the undergraduate (UME) to graduate medical education (GME) transition. A pilot of ILPs in pediatrics demonstrated moderate usefulness. However, within internal medicine (IM), there currently is no ILP process or learner handoff once students match into residency.
Purpose: The Alliance for Academic Internal Medicine Learner Handoff Standards Task Force created an ILP to be piloted in IM to articulate incoming interns’ clinical/academic goals and areas for improvement. Section 1 asked students to describe their top 3 clinical/academic goals for the first 6 months of residency (free response). Section 2 asked students to rate their preparedness for internship across 16 domains (e.g., writing orders and prescriptions), assessed on a 5-point Likert scale (1 = not at all prepared, 5 = extremely prepared). Section 3 asked students to identify their top 3 areas for improvement for the first 6 months of residency (free response). Section 4 asked students to select 3 core IM topics they felt least prepared for during internship (e.g., shock).
Description: The pilot took place in spring 2022 with 57 IM residency programs. Programs asked incoming interns to complete the ILP with a faculty advisor if possible. ILPs were returned to respective programs and utilized per program discretion. IRB exemption was obtained to evaluate anonymous ILP data from a sample of participating programs for preliminary assessment.We evaluated ILPs from two IM residency pilot programs. Return rate of ILPs was 100% (17/17) in one program and 61% (22/36) in the other. Of the 39 respondents, 59% (n=23) graduated from US allopathic schools, 21% (n=8) from US osteopathic schools, and 21% (n=8) from international medical schools.Respondents felt most prepared with “recognizing when to ask for help” (mean=4.1, SD=0.78) and “performing a relevant and appropriate physical exam” (mean=3.8, SD=0.67). Respondents felt least prepared for managing patients in ICU settings (mean=2.0, SD=0.92) and writing orders and prescriptions (mean=2.5, SD=1.02) (Table 1). Oncologic emergencies was identified as the core IM topic for which students most commonly felt least prepared, selected by 24 students (62%). No students identified congestive heart failure, pneumonia, or syncope as core IM topics for which they felt least prepared (Table 2). Among clinical/academic goals for the first 6 months of residency, efficiency and research/career exploration were common themes, with 17 (44%) and 14 (36%) students respectively identifying these themes. Among self-identified areas for improvement, ICU level care was a common theme, selected by 62% of students (n=24). Students took an average of 29.8 minutes (SD=14.8 min) to complete an ILP, and faculty members took an average of 19.1 minutes (SD=9.7 min) reviewing the ILP. 64% (n=25) of completed ILPs were signed by UME faculty members.
Conclusions: Preliminary ILP data suggests there are common themes among self-identified areas for improvement among incoming IM interns, particularly regarding critical care and hematologic/oncologic medicine, as well as a desire to develop efficiency during intern year. Evaluating ILPs from the remaining residency programs will help elucidate broad curricular changes, as well as how to better coach interns through the UME to GME transition.