A National Consensus Process to Establish Common Topics for Transition to Residency Courses.

Purpose: Transition To Residency (TTR) courses are designed to prepare graduating medical students to more seamlessly transition into the role of an intern and have become increasingly common in U.S. medical schools.1–3 There is variation in the goals and structure of these curricula and some have begun to conceptualize the “transition to residency” as encompassing most of the post-clerkship timeframe of medical education.4 There is a need for evidence-informed guidance for curriculum development in existing and new TTR courses. Establishing a consensus-based common set of TTR course skills will facilitate standardized internship preparation and would encourage collaboration amongst TTR educators at different schools. Method: We conducted a modified Delphi approach to establish a set of skills that should be taught in a TTR course. We used a predefined definition of consensus as > 75% of the stakeholder panelists selecting a positive response on a Likert-based questionnaire during 1 of 3 survey iterations. With subsequent iterations, nonconsensus skills were modified, and additional skills were added. The initial set of skills was derived through an inclusive brainstorming process with 9 national experts in TTR (Expert Panel) and supplemented by 15 skills uncovered in a literature search for a total of 104 skills on the initial survey. The Stakeholder panel participants were solicited via open email invitations to a national TTR course directors listserv and residency program directors participating in the Accreditation Council for Graduate Medical Education (ACGME) Milestone’s 2.0 development. Stakeholder panelists extended additional invitations to residents at their institutions. Skills meeting consensus were distributed via a fourth survey asking panelists to assign an expected level of entrustment for course graduates using an anchored Likert survey with 1 = low and 6 = high entrustment expectations. Results: The Stakeholder panel initially consisted of 118 respondents from 15 specialties that identified as a: TTR course director (n = 83, 70%), graduate medical education leader (n =12, 10%), or resident (n = 18, 15%). Response rates were 54% in iteration #2, 42% in iteration #3, and 33% on the final entrustment questionnaire. 54 skills met consensus and similar skills were then grouped into 37 final skills. The number (n) and examples of skills in each domain are: Clinical Skills (18) Assessment and management of common inpatient complaints (i.e., acute pain, altered mental status, chest pain, fever, nausea/vomiting, shortness of breath) Identification and stabilization of a critically ill patient Recognizing and reporting patient safety issues Communication Skills (14) Delivering serious news/difficult conversations Effective communication and de-escalation in difficult provider–patient interactions Effective communication of care transitions (handoffs and signout) Personal/Professional Skills (4) Effective prioritization of daily clinical tasks Application of strategies for personal wellness and resilience Effective supervision and teaching of learners (i.e., medical students) Procedural Skills (1) Performing mask ventilation Ideal entrustment levels based on response medians from the final survey were assigned to each skill with most skills having an entrustment level of: 3—Perform independently but be directly watched (n = 7); 4—Perform independently and have ALL findings double checked (n = 19); and 5—Perform independently and have only KEY findings double checked (n = 9). Discussion: Through a modified Delphi process, we identified 37 core skills that should be considered when designing TTR courses. Our Stakeholder panel had broad representation across specialties, training levels, and educational contexts. Entrustment guidance with each skill can help educational leaders determine the depth of education and training needed for a given skill and more efficiently direct resources to the most high-priority sessions. Significance: This work serves as the foundation for a common framework for designing TTR course objectives and will allow for more TTR educator collaboration and the creation of a standardized national curriculum.