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Curriculum Resources Project
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POST CLERKSHIP TRAINING RESOURCE (PCTR)
The final component of the Family Medicine Curricular Resource project (FMCR) includes a detailed analysis of elective education and training in family medicine that may follow the clerkship component. The contract mandated that: "The contractor shall propose 'new competencies for consideration by the family medicine and broader educational community.' The product of this contract shall be a three part faculty resource document that can be used by family medicine medical school faculty and their medical school and community colleagues who are engaged in the process of improving medical education." Further, "the contractor shall propose 'consultants from the broad community of medical education' to assist in providing the (project) with new information and evidence to guide the articulation of new competencies needed to better prepare students to enter residency training in any chosen specialty." The purpose of the Post-Clerkship Training Resource (PCTR) is to help educators design curricula for the senior year of medical school.
The process of developing the PCTR included numerous interactive sessions with family medicine educators engaged in student education and those involved in family medicine residency education. Additionally, this component was informed by the work of the contract workgroup of experienced educators in the primary care disciplines that addressed clinical competencies necessary for medical students prior to beginning the traditional third-year clerkships. These groups, as well as the Advisory Committee of the contract, reviewed the competencies in an iterative fashion. The work is very consistent with a recent article by Hueston, Coopman, and Chessman addressing curricula for fourth-year students planning on entering family medicine, which also references suggested fourth-year electives across several other specialties. Given that medical education is a continuum through four years of medical school, into residency, and beyond, and in light of the spiral theory of education, it was deemed appropriate to revisit those competencies suggested for entering third-year students, in terms of possible exit competencies from medical school. As with the preclerkship and clerkship components, the PCTR is structured utilizing the ACGME six-domain rubric. Also, as with the previous components, there has been an attempt to address the appropriate level of proficiency for graduating medical students. Reinforcement throughout the four years of medical school is critical to achievement of these important competencies before entering residency training. The intent of this document is NOT to prescribe specific curricula for any school, but to describe a range of clinical competencies to be achieved by medical students upon graduation. As with the preclerkship component, the PCTR does not address competencies for the basic sciences or the content of specific specialties during the required clerkships of the third-year or fourth-year electives. Also congruent with the preclerkship component, the competencies address the whole person, and higher levels of social complexity (dyads, families and other groups, the community, and the larger environment).
While the contract instructs the project product specifically to address competencies for family medicine educators to define during post-clerkship training for students entering family medicine residencies, it also proposes articulation of competencies needed to prepare students better to enter residency training in any chosen specialty. The resource is constructed to accomplish both goals.
It is possible that advisors for the fourth-year experience of students headed for a career in family medicine will find this set of competencies useful, as will advisors for students choosing other specialties. The literature from several disciplines suggests that a broad range of experiences is important in preparation for residency. Therefore it seems reasonable in this product to link the six ACGME competencies for residency clearly to exit competencies for medical school. It is also possible that family medicine residency directors (and directors of other residencies) may use this product to assess incoming residents' proficiencies in order to design curricular experiences to facilitate optimal learning.
To repeat from the introduction to the preclerkship component: "Readers will appreciate that multiple areas in a medical student curriculum will overlap the ACGME domain areas. We chose to describe some competencies under multiple domains, as an indication of their importance (e.g., communication skills, life cycle issues, and team-based care are found in several sites, and active/lifelong learning objectives are seen in nearly all domains).
We hope that the reader will perceive those themes that are interwoven through this document: that the patient's concerns, values, and outcomes must be the center of care; that partnering with an activated patient is essential; that self-awareness is essential in being an effective physician; that improving the process of care and health outcomes is the physician's responsibility and requires a systems-based approach; and the four years of medical school are only the foundation of an active learning process for which the student of medicine will be responsible throughout life."