A Capstone Course for Senior Medical Students

Purpose: Many medical schools have largely elective fourth-year curricula that allow for schedule flexibility but may not optimally prepare students for the transition to residency. 1,2 Recently, the Coalition for Physician Accountability Undergraduate Medical Education (UME)-Graduate Medical Education (GME) Review Committee (UGRC) recommended specialty-specific transition to residency training for all medical students. 3 Approach: We developed a limited fourth-year Capstone internship preparation course in 2012 and describe its evolution into a required course by 2015 and an increasingly specialty-specific course in its current structure in 2020. After the Accreditation Council for Graduate Medical Education changed its intern duty hours policy in 2011, the course was conceived as a method of better preparing graduates to succeed in this new environment. Since its inception, the course has grown from a single 2-week course for 30 students to a required 4-week course offered twice per year. Through student and graduate feedback, the course has been tailored toward individual residency training competencies. Outcomes: From 2012 to 2020, 891 fourth-year students have completed the Capstone course. The number of course directors has fluctuated from 2 (2012–2014) to 1 (2015–2019) to 4 (2020). Course director support has increased from a total of 0.0 (2012) to 0.4 (2020) full-time equivalent. Postcourse ratings were significantly higher than precourse ratings for both residency preparedness and confidence. Course quality ratings remained high in the transition from an elective to a required course. Graduates who had taken Capstone as an elective (2012–2014) overwhelmingly agreed it was useful in preparing for their responsibilities at the start intern year (97%). After the Capstone course became a required part of the core curriculum, most respondents (89%) continued to agree that the course was useful in preparing for their responsibilities at the start of residency. Significance: Our Capstone course’s evolution over 9 years was grounded within a multidisciplinary collaborative process for course planning and administration since the course’s inception, and course changes are driven by robust student feedback. Although the course is labor intensive, it provides valuable instruction and content for senior medical students during a less structured point in the academic year. In 2013 and 2014, a committee within the Clerkship Directors in Internal Medicine examined published literature and websites of 136 Liaison Committee on Medical Education (LCME)-accredited schools for information on current fourth-year course offerings. 4 At that time, Capstone courses were required at 59% of US LCME-accredited medical schools, with durations from several days to 4 weeks, usually offered toward the end of the academic year though some interspersed with periodic sessions. Per the LCME Part II Annual Medical School Questionnaire, the percentage of U.S. medical schools with required, transition to residency courses has increased from 58% in 2016 to 75% in 2020. Only 30% of medical schools offered one generic course for all students in 2016, but that increased to 71% by 2020. Capstone courses may be particularly fertile ground for curricular change and implementation of uniform curricular components across medical schools to optimally prepare students for the responsibilities they will assume at the start of intern year. The UGRC recommendations will likely increase interest at the national level for joint efforts by educators across the undergraduate to graduate medical education continuum to optimally prepare learners for the start of residency training. 3 The evolution of our school’s Capstone course, providing one such example of joint efforts across the UME–GME continuum, highlights both the opportunities and challenges for innovation in transition to residency curricula and may serve as a template for institutions looking to start a Capstone type course or expand their course content and structure

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