Michele Long,MD, Elizabeth Stuart, MD, Stanford, Palo Alto, CA
BACKGROUND: Pediatric residency training requirements mandate that all residents maintain an Individualized Learning Plan (ILP). Previous work suggests that residents have difficulty identifying learning goals to include in ILPs (Stuart, 2005). Using the emerging COMSEP 4th-year curriculum as a guide, we developed an ACGME competency-based sub-internship curriculum that emphasizes reflective practice, practice-based learning and improvement (PBLI), and working with an ILP. METHODS: The new curriculum, launched in 2008, prepares students to: work at the level of a new intern in managing patient care, outline the ACGME Competencies, use reflection on clinical experiences to create an ILP. Students meet with the rotation director weekly. Orientation includes an overview of goals, a review of the ACGME competencies, and guidelines for developing ILPs. In follow-up, students review progress toward established goals and reflect on clinical encounters in order to identify new learning needs. At the end of each rotation, students complete a retrospective pre-/post-clerkship self-assessment survey. We analyzed changes in self-assessed comfort and skill in several domains, including identifying learning goals and using an ILP. We performed a content analysis of students’ ILP goals and reviewed comments and ratings from formal course evaluations. RESULTS: 11 students have completed the new sub-internship and self-assessment survey. Self-assessment responses show significant positive changes in all domains, including ability to work with an ILP. Analysis of students’ ILPs revealed several common goals: improving presentations (9 students, 82%), refining communication with patients (64%), taking primary responsibility for patient care (45%), becoming comfortable dictating medical records (36%) Course ratings are similar to the past (overall 4.5/5). Comments indicate that students value the sessions with the rotation director. CONCLUSIONS: The new curriculum has been well received and effective in providing deliberate practice with PBLI.