Implementation of a Standardized Sub-Intern Curriculum Improves Confidence for those Entering a Surgical Residency

OBJECTIVE: Medical students often feel underprepared entering surgical residency. We have previously reported the results of a sub-intern needs assessment (SINA) which informed the creation of a standardized sub-internship curriculum. We aimed to determine if implementation of this curriculum into students' sched-uled rotations would improve student confidence in their abilities related to the AAMC Core Entrustable Pro-fessional Activities for Entering Residency (CEPAERs).DESIGN: We surveyed 4th year medical students during their surgery sub-internship. Sub-interns participated in a weekly series of 2-hour didactic sessions. We utilized interactive lectures and case scenarios addressing the pertinent topics identified in our previous needs assess-ment. The surveys were administered before and after the rotation and linked using unique identifiers. The sur-veys assessed confidence in each of the CEPAERs as well as the top 25 topics prioritized by our needs assessment. Self-reported confidence in each of the topics was mea-sured using Likert scales (CEPAER scale 1-5, SINA scale 1-6). Pre-and post-curriculum confidence on a variety of topics were compared using paired t-tests.SETTING: Geisel School of Medicine at Dartmouth/Dart-mouth-Hitchcock Medical Center, a tertiary-care aca-demic medical center. PARTICIPANTS: Fourth year medical students participat-ing in their general surgery sub-internship.RESULTS: Twelve medical students participated in gen-eral and thoracic surgery sub-internships over the course of the study period. Ten (83%) participated in the didac-tic curriculum and they all completed both the pre-and postsurvey. 100% of the respondents agreed that the cur-riculum provided a useful supplement to their clinical experience. With respect to the CEPAERs, students reported improved confidence in 77% of the areas, with statistically significant increases occurring in the follow-ing areas: ability to prioritize a differential diagnosis (average Likert rating improved from 3.7 to 4.1, p = 0.04), comfort entering and discussing orders (2.9-3.8, p = 0.007), and overall preparedness to be a surgical intern (3.2-3.8, p = 0.02). Students also reported improvement in confidence in 92% of the basic intern responsibility topics, with statistically significant increases in maintenance fluid calculations (Likert rating 3.5-4.5, p = 0.001), repleting electrolytes (3.8-4.6, p = 0.01), interpretation of chest and abdominal x-rays (4-5, p = 0.02; 3.6-4.5, p=0.004, respectively), manage-ment of oliguria (3.2-3.8, p = 0.02), and time manage-ment/organization skills (4.5-5.4, p = 0.04). CONCLUSIONS: Implementation of a standardized sub -intern curriculum improved student confidence in 33 of the 38 basic intern responsibilities, core Entrustable Pro-fessional Activities, and overall preparedness to be a sur-gical intern. While limited by a single institution design, we believe these results offer a new avenue for educat-ing and preparing medical students for residency within their existing sub-internships.( J Surg Ed 79:1402-1412. (c) 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) ABBREVIATIONS: CEPAERs, AAMC Core Entrustable Professional Activities for Entering Residency SINA, Sub -Intern Needs Assessment ACGME Core Competency Practice-Based Learning and Improvement

Automated summary

The implementation of a standardized sub-internship curriculum in students' scheduled rotations can improve student confidence in their abilities related to the AAMC Core Entrustable Professional Activities for Entering Residency (CEPAERs).