Increasingly restrictive ACGME supervision requirements for PGY‐1 residents in the inpatient setting have been interpreted by some as a reflection of insufficiently prepared medical school graduates.


Curricular enhancement to fourth medical school curriculum with a particular focus on specialty specific inpatient topics relevant to the intern year can be an important tool in addressing the issue of PGY1 preparedness to deliver optimal supervised care. While many schools offer capstone courses, the content and format are widely variable. Prior to 2012, our capstone course consisted of ten half‐days of large‐group lectures and a final exam. We set out to redesign our capstone course with a special emphasis on increasing our fourth year students’ exposure to high yield topics for the intern year with an obvious emphasis on inpatient care.


Following a stakeholder retreat, a multispecialty work group of clerkship and sub‐internship directors was convened to redesign the course. Following faculty input, the course was redesigned to include interactive, case based, “breakout sessions” addressing important discipline‐specific competencies. Large‐group sessions were updated with the goal of ensuring content was pertinent to all interns, regardless of specialty choice.Voluntary breakout sessions in medicine, surgery, critical care and pediatrics were designed, including twelve half‐hour internal medicine sessions offered over two days. Topics relevant to hospital medicine received particular attention in medicine breakout sessions. Breakout session content was not included in the final exam.

A total 72 students and 11 faculty members participated in medicine breakout sessions. Students were divided into groups of 12 each. Topics covered during medicine breakout sessions and student reported learning value are as follows: pain control (4.5/5), calling consults (4.7/5), rapid response scenarios (4.9/5), interns as teachers (4.7/5), fever (4.6/5), hypoglycemia (4.2/5), hypo‐ and hyperkalemia (4.9/5), the violent patient (4.4/5), respiratory depression (4.9/5), transfusion medicine (4.9/5), hyponatremia (4.8/5), inpatient status and documentation (3.7/5), and procedure workshops (4.6/5). Student evaluation of medicine breakout sessions showed satisfaction with selection of topics (4.4/5), organization of content (4.4/5) and relevance to intern year (4.7/5). The revised capstone course received overall ratings of 4.0/5, 4.1/5 and 4.0/5 for effectiveness in preparing for internship, relevance across specialties and educational value, respectively.


Despite their voluntary nature, small group internal medicine breakout sessions were well‐attended and highly‐rated complements to a redesigned multidisciplinary capstone course. Though time‐intensive for faculty, breakout sessions may help others redesign similar courses. Development of multidisciplinary consensus by local experts to identify key competencies required of incoming interns in different specialties was extremely helpful to us in redesigning our capstone course, but national collaboration among undergraduate and graduate medical education leaders within hospital medicine – and across specialties – to refine capstone course goals and competencies expected of starting interns would be useful for curricular redesign.