As the new academic year approaches, we prepare to welcome a new cohort of surgical interns. For the newly graduated medical student, it is a time of both anticipation and trepidation, with many soon-to-be interns expressing concerns about their preparation for the rigors of surgical residency. Surgical educators have long mirrored these concerns, bringing up a number of issues that potentially impact the readiness of medical school graduates to transition from the role of student to that of a resident.1 Concerns include the variability of medical school curricula; increased marginalization of students on clinical rotations, and fourth year schedules that consist largely of electives of variable rigor and relevance.
However, a number of invested parties have turned their attention to improving this transition from learner to practitioner, and have begun instituting innovative experiences at both a local and national level.
Surgical Boot-Camps
Over the past decade, many medical schools have developed dedicated intern preparatory (“boot camp”) electives. These courses are typically offered in the final months of the fourth year of medical school, to maximize their immediate relevance to students. A recent meta-analysis summarized the findings of several single-institution studies, showing significant improvements in technical skills, clinical knowledge, and confidence.2
The success of these courses have led to increased interest nationally. The American College of Surgeons (ACS), Association of Program Directors in Surgery (APDS), and Association for Surgical Education (ASE) have jointly developed a standardized resident prep curriculum, which over the past two years has been implemented at over forty American medical schools.3 They offer an online modular curriculum with modules covering a number of patient care domains such as radiologic image interpretation, common clinical scenarios, and order entry and prescribing exercises.
Mock Paging
One of the most frightening aspects of intern year is the first time your pager goes off in the middle of the night, with news of a sick patient or an unexpected clinical scenario. Medical students typically receive little experience as the first line contact for patient care.
Now, there are some scenarios that no preparation course can anticipate. But an important and novel aspect of the surgical bootcamp curricula has been the inclusion of a mock paging program. Southern Illinois University School of Medicine has been a leader in developing and centralizing this effort, in which experienced nurses page participants with detailed clinical scenarios and interact with the students in a realistic fashion.4 These scenarios are developed by a team of surgeons and nurses, and the scenarios often include specific communication challenges such as a new/inexperienced nurse who does not provide complete information. Students are evaluated and given immediate and direct feedback on their performance.
Students who participate in this program improved their clinical performance significantly. Perhaps most importantly, when surveyed these students indicated increased confidence and decreased anxiety regarding receiving and answering pages independently.
Fundamentals of Surgery Curriculum
Perhaps in recognition of the concerns regarding graduating students’ readiness to transition into the role of intern, the Accreditation Council for Graduate Medical Education in 2011 increased new requirements for supervision of trainees.5 These regulations included requiring direct supervision of interns performing common clinical care tasks, such as management of postoperative oliguria, in addition to technical tasks.
In response to these regulations, the American College of Surgeons introduced an online curriculum with 99 different clinical case scenarios.6 This curriculum allows program directors to monitor residents’ progress and to certify that they are ready to progress from direct to indirect supervision within the ACGME regulations. Residency programs have begun implementing this curriculum for their interns as early as during employee orientation, but some have suggested merging this tool with other efforts such as the fourth year boot camps.
Integrating efforts and preparing for the Future
The collaboration between professional societies, through the development of the national resident prep course curriculum, represents an important step forward. One of the major concerns regarding the transition from medical school to residency is the variability from medical school to medical school, and the inconsistency this creates in the graduating student. It seems that at present, we have a unique level of national interest among surgical societies in more deliberately interacting with and improving undergraduate medical education
Our hope is that these efforts will continue to grow, and that the steps being undertaken today – boot camp courses, national collaborations, development of standardized and widely available curricula – will help prepare medical school graduates to face July 1 with increased excitement and decreased anxiety in future years.
References:
- Minter RM, Amos KD, Bentz ML, et al. Transition to Surgical Residency: A Multi-Institutional Study of Perceived Intern Preparedness and the Effect of a Formal Residency Preparatory Course in the Fourth Year of Medical School. Acad Med 2015.
- Donnon CBaJAaSRLaT. Effects of Postgraduate Medical Education “Boot Camps” on Clinical Skills, Knowledge, and Confidence: A Meta-Analysis. Journal of Graduate Medical Education 2014; 6(4):643-652.
- ACS/APDS/ASE Resident Prep Curriculum 2014. Available at: http://www.facs.org/~/media/files/education/acsapdsasebrochure.ashx. Accessed May 20, 2015.
- Frischknecht AC, Boehler ML, Schwind CJ, et al. How prepared are your interns to take calls? Results of a multi-institutional study of simulated pages to prepare medical students for surgery internship. Am J Surg 2014; 208(2):307-15.
- Nasca TJ, Day SH, Amis ES, Jr., et al. The new recommendations on duty hours from the ACGME Task Force. N Engl J Med 2010; 363(2):e3.
- ACS Fundamentals of Surgery Curriculum 2014. Available at: http://www.facs.org/education/program/fsc. Accessed May 22, 2015.