By Peter Carrels
There are approximately 500 internal medicine residency programs in the United States, and residents at USD Sanford School of Medicine’s internal medicine residency program earned the nation’s top performance scores. Residency leaders credit a curriculum redesign for this impressive achievement.
In 2014, leadership of USD Sanford School of Medicine’s internal medicine residency embarked on an ambitious redesign of curriculum and all other aspects of the three-year program. “We completely overhauled the program,” said Dr. Joseph Fanciullo, director of the residency.
Fanciullo and others at the medical school wanted to create a residency that was more responsive to the needs of residents and would better serve patients, too. “We prioritized resident well-being, including having our residents work more reasonable hours, and we also greatly reduced the number of overnights they worked,” explained Fanciullo. “We wanted the residents to be more engaged with their patients during their clinical rotations by minimizing conflicts in their clinical schedules.” This new model, he added, also provided the opportunity to integrate or weave together the various components of internal medicine, and that strengthened resident preparation for practice.
The results of this curriculum restructuring, said Fanciullo, began to quickly reveal themselves. “Within one year, our in-training examination scores began to climb,” he reported.
So-called in-training exams are annually administered to residents in nearly every residency program across the country, not just internal medicine residencies. The exam and its results – known as a program performance tool – allow the many different residency programs in many different specialties to understand resident knowledge as well as their own successes and shortcomings. It also enables each program to evaluate their standing when contrasted with similar subject programs.
By 2018, when resident in-training exam scores are most recently available, it had become clear that USD’s revamped curriculum appeared at least partially responsible for an astonishing fact: Scores on the in-training exam by USD’s internal medicine residents topped those scores recorded by residents at all other internal medicine residency programs in the country. USD Sanford School of Medicine’s internal medicine residents in their second and third years posted exam scores that were rated at the 100th percentile of all internal medicine residency programs in the United States. It’s worth noting that across the nation there are approximately 500 internal medicine residency programs, and that more than 7,000 residents are training in each of the three years of a residency at these different residencies.
"Our residents are pursuing excellence like never before. They are challenging themselves to become better physicians, and we are witnessing this high level of ambition throughout the residency program." - Dr. Joseph Fanciullo
Those outstanding 2018 test scores at USD’s internal medicine residency continued a sharply rising trajectory. In 2017 scores had already elevated the program to nationally significant stature. This important metric – the results of in-training exams – has also portended impressive certification exam success by residents. One hundred percent of those residents who have completed the program within the past three years and have taken the American Board of Internal Medicine certification examination have passed the exam.
Although the residency’s leadership expects exam scores to remain exemplary, many factors – some unrelated to the program – can impact results. “Sustaining this level of excellence,” Fanciullo acknowledged, “is a big challenge, but a good one.”
Fanciullo reported that he is hearing lots of positive feedback about the program’s residents. “Other physicians are telling me how impressed they are with the quality of our residents,” he said. “It’s also gratifying to see that many of our residents are being hired by health care facilities in South Dakota.”
USD’s categorical internal medicine three-year residency program contains 24 residents, with eight residents training each year.
Typically, close to 1,600 recently graduated students from medical schools located around the world apply to enter USD’s internal medical residency program.
“Through this highly competitive situation, we’ve been able to determine that the graduates of certain medical schools and certain types of applicants best fit our program,” said Fanciullo. “That helps us determine which applicants to select.”
The program relies on outstanding teaching physicians and the support of both Avera and Sanford in Sioux Falls. “Both institutions,” explained Fanciullo, “have been highly supportive of the residency.” According to Fanciullo, the program’s redesign involved the support, input and energy from all levels of the medical school. “The dean, the program’s leadership, its faculty and the residents themselves participated in this effort.”
Fanciullo noted that the curriculum redesign not only increased exam scores, but it has compelled a deeper level of devotion by residents. “Our residents are pursuing excellence like never before,” said Fanciullo. “They are challenging themselves to become better physicians, and we are witnessing this high level of ambition throughout the residency program.”