The clinical goals of medical school are to ensure that graduating students have the capacity for disease management, coordination of care, and effective communication for multiple patients. A specific skillset is needed to successfully achieve competency in these areas. We sought to assess the current state of clinical medical education across the nation from the student’s perspective in regards to developing the skills necessary to succeed as an intern. We identified writings notes, writing orders, and answering pages as the essential skills necessary for a successful transition to intern year.


We created an anonymous survey and administered it via the AAMC OSR listserv in September 2013 to representatives from 82 American medical schools. Participants were asked to respond on behalf of their peers, with only one respondent per school. There was a 2 week collection period, after which preliminary data was analyzed. The survey was subsequently re‐opened for another month and the data again analyzed.


We received responses from 44 schools, a 53.7% response rate. Among MSIIIs, 43.2% wrote orders on at least one clerkship, while 71.8% of MSIVs wrote orders as a sub‐intern. Students were more likely to have written orders on internal medicine rotations than on any other core clerkship. The vast majority of written orders required cosigning (87.2%). Most orders were related to labs (72.3%), medications (70.45%), and consults (54.6%). While nearly 80% of MSIIIs reported receiving a pager on at least one clerkship, only 53.3% of MSIIIs reported ever having received a page. Among MSIVs, again nearly 80% reported having received a pager on at least one clerkship, and 65.9% reported ever having received a page. New responsibilities taken on during the sub‐internship included writing orders (61.7%), increased patient load (26.5%), increased autonomy (26.5%), calling consults (20.5%), and being the first provider paged with patient concerns (17.6%). Student recommendations to improve the role and responsibility of MSIV students in patient care included: order writing (46.2%), answering pages (23.1%), increased autonomy (23.1%), better defined roles (7.7%), and a longer Sub‐I (3.8%).


Nearly a third of graduating medical students have neither written an order nor answered a page before starting their intern year. Similarly, only a quarter of fourth year students experience a higher patient load than during their third year clerkship. Our data suggest that there is a skillset gap between what is expected of interns and what students are taught during the clinical years of medical school. Students themselves have identified these skills as an opportunity to improve clinical curriculum in the fourth year of medical school.