The General Internal Medicine (GIM) Acting Internship (AI) is a one-month long mandatory rotation at our institution. Fifteen students on the AI rotate at four different sites each month. Didactic sessions, hereby referred to as “academic half day”, are offered weekly. Historically, such academic half days were 60–75 minutes in duration and covered morning report style case-based topics where one student presented a case, and a facilitator would walk the group through the differential diagnosis and management of the case. The attendance at these voluntary sessions was anecdotally reported at 40–50%. We redesigned our AI academic half day at the beginning of the academic year by soliciting student input into selection of topics.
Two weeks prior to the beginning of the AI, we emailed enrolled students a survey asking them to rank “topic-based sessions” and “case-based sessions” on a scale of 1 to 5 (1 = not at all interested, 5 very interested). Six “topic-based sessions” were initially included on the survey- Arterial Blood Gas (ABG) interpretation, Electrocardiogram (EKG) interpretation, approach to common cross cover scenarios, approach to common inpatient medicine diagnoses, radiology overview and discussion of inpatient medicine specific multiple-choice questions pertinent to United States Medical Licensure Examination step 2-clinical knowledge exam. We also surveyed participants on their preference for morning report style “case-based sessions”. Brief descriptors were provided as part of the survey so students would have a sense of what each session would entail. These topics were chosen based on the CDIM curriculum and input from local leaders in undergraduate medical education at our institution. The survey allowed students to write-in topics that were not listed on the survey. Based upon consistent student feedback during the first three months, we added an eighth session to the survey, approach to using antibiotics. Each month, we chose 4 top-voted “topic-based sessions” for inclusion in the academic half day. Most of the topics were taught by the course director for the first three months. By the end of the year, four different faculty members, including the course director, were teaching these topics. Interactive, case based, small group sessions were designed to teach each “topic-based” session. Each “topic-based” session was taught for one to three hours. Three out of four academic half day sessions each month were randomly chosen to be dedicated to “topic-based sessions”. The fourth academic half day each month was allocated as a “case-based session”. All students were asked to come prepared with a case in mind to present at these sessions. A faculty member served as the moderator and led the discussion. We conducted a total of thirty-two academic half days on the AI over eight months. We did not conduct academic half day for four months in the year due to low student enrollment in the course during December, January, May, and June.
We framed attendance at academic half day as recommended but not required. The course director explained to the students how academic half day content was determined during the monthly course orientation. The course director recommended to the students that they attend all sessions. However, students were given agency over attending by giving them the choice to skip academic half day if they had a learning opportunity on the wards that they felt was more conducive to their learning. Students were asked to send an email to the course coordinator stating their reason for not attending in 1–2 sentences. Students were excused from attending on their day off and on post night call day. Attendance at each academic half day was tracked by asking students to sign in at arrival.
For topic-based sessions, students ranked their comfort level in recognizing or managing the various sub-topics under discussion both before and after the session on a 5-point scale, with “1” being “not at all comfortable” and “5” being “very comfortable”. Paper forms were handed to students at the beginning of the session and collected at the end.
Mean score on the 5-point Likert scale was used to illustrate student preference for topics covered during academic half day. Data was analyzed using student’s t-test when comparing attendance and paired t-tests when measuring change in student comfort level with addressing the various topics covered during academic half day.