Building Bridges to Residency: Targeted Interventions to Increase Autonomy in the Fourth Year

On day one of residency, new interns are expected to have mastery of a standardized clinical skillset. The fourth year of medical school is critical to preparing for this transition and requires students to achieve a higher level of autonomy than experienced during clerkships. However, students often spend their fourth year involved in more passive learning than direct clinical engagement. Studies suggest that students at different institutions experience varying degrees of autonomy in patient care and clinical exposure during their final year of medical school, including both subinternships and electives. Educators working with fourth year students experience significant challenges in providing sufficient autonomy to students to adequately prepare them for residency. Maximizing autonomy for fourth year students requires a four-pronged approach: individual recognition of the need for increased student autonomy and modification of direct teaching methods in the clinical learning environment; implementation of faculty and resident development that empowers clinical teachers to encourage autonomy for fourth-year clinical rotators; curricular innovation and development of new clinical or simulation-based courses; and advocacy for policy change within institutions to allow students to take on new responsibilities (i.e. billing for documentation, cross-coverage, etc.). In this workshop, presenters will describe a variety of efforts at four institutions that promote autonomy and active learning in the fourth year through individual teaching practices, curricular change, policy change, and faculty development. Audience interaction will include think-pair-share and two break-out sessions in which participants create a draft plan for a new intervention at their institution.