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    Boot Camps Prepare Medical Students for the Rigors of Residency

    Students practicing surgery
    Fourth-year students at Johns Hopkins University School of Medicine practice surgical skills in a boot camp before beginning surgical residencies.
    Christian Jones, MD, MS

    In early May, fourth-year medical students at Johns Hopkins University School of Medicine tested their surgical skills and knowledge at a residency prep event known as the Surgical Olympics. Faculty member Christian Jones, MD, MS, said he especially looks forward to the day’s final event—a Jeopardy-style competition.

    “That’s one of the best parts; I get to play Alex Trebek,” said Jones, assistant professor of surgery at Johns Hopkins Medicine.

    The Surgical Olympics wrap up a week-long, voluntary boot camp for Johns Hopkins students who are about to begin surgical internships. While it certainly has its fun moments, the event has a serious mission: to better prepare graduating medical students for the rigors of residency. The Johns Hopkins boot camp is part of a nationwide pilot project that is testing a new residency prep curriculum specifically for incoming surgical interns. The pilot is a collaboration of the American College of Surgeons, Association of Program Directors in Surgery, and the Association for Surgical Education.

    “The overall goal of the boot camp is to get an insider’s view of what it’s like to be a surgical intern,” Jones said. “If we can help students become more successful, then we’re benefiting residency programs all over the world.”

    Small group simulation sessions provide fourth-year medical students from Northwestern University Feinberg School of Medicine an opportunity to practice skills in preparation for their transition to residency.
    Northwestern University

    Research shows that there is often a gap between what residency program directors expect and what newly graduated physicians can do. For example, survey results published in 2013 in Family Medicine found that more than 80% of family medicine interns said they could independently perform only one-third of the 15 procedures expected by residency program directors. Another study in Academic Medicine reported that interns commonly struggle with a lack of organizational skills and professionalism as well as gaps in medical knowledge.

    The surgical preparedness pilot program is not the only preresidency boot camp designed to address readiness gaps. Many medical schools offer specialty-specific boot camps that serve as refreshers on knowledge and skills and provide an up-close look at the hectic, demanding job of a resident.

    “I think the public expects newly minted interns to have certain basic clinical skills,” said Diane Wayne, MD, vice dean for education and the Dr. John Sherman Appleman Professor of Medical Education at Northwestern University Feinberg School of Medicine. “And we need to maintain that public trust by making sure they do.”

    Focus on core competencies

    At Northwestern, a fourth-year boot camp, initially piloted in 2015, uses the AAMC’s Entrustable Professional Activities (EPAs) for Entering Residency, a list of skills students should master by the time they begin residency. According to a 2016 evaluation, the prep course led to improvements in students’ core clinical skills and is now a two-week, simulation-based capstone course required for all fourth-year medical students.

    During the course, students demonstrate a mastery of select EPAs, such as writing admission orders and prescription discharge instructions, and learn how to balance the demands of residency with everyday life. Students take part in subspecialty tracks during the boot camp as well. About 10% to 15% of students discover they do need indeed to practice and master the course’s EPA requirements before beginning residency, according to Wayne.

    Northwestern University Feinberg School of Medicine practice their intubation skills
    Graduating medical students from Northwestern University Feinberg School of Medicine practice intubation skills during a capstone course before starting their residency programs.
    Northwestern University

    “Nothing can replace learning with patients and learning on the wards, but the experiences are variable, and you’re never sure what you’ll encounter,” Wayne said. “In the simulation lab, we can assure the experiences are standardized and assessed.”

    Michael Conrardy, MD, who recently graduated from Northwestern and began an emergency medicine residency, said the boot camp gave him an opportunity to practice skills common for an intern but not so common for a medical student. For instance, he got to practice call-in consults, administering IVs, writing prescriptions with pen and paper (instead of with a computer), and creating admission orders. He said the experience revealed he needed to beef up his admission order skills—so he practiced more and improved significantly.

    “The boot camp has definitely made me less nervous going into residency,” he said.

    A mix of clinical skills and work-life balance

    The University of Michigan Medical School began its fourth-year boot camps in 2009 with a prep course for surgical residents. Since then, the school has added four-week residency prep courses for OB/GYN, pediatrics, and internal medicine and plans to pilot one in primary care next year. By 2019, the school hopes to offer an eight-week course that incorporates all the specialties as well as common core topics, according to Helen Morgan, MD, an assistant OB/GYN professor and director of the residency prep courses.

    The prep courses are structured around the Accreditation Council for Graduate Medical Education’s entry-level milestones for new residents, Morgan said. The curriculum is light on lectures and heavy on simulation-based active learning. For instance, nurses send mock pages to students throughout the four weeks, with some pages coming during class and others in the middle of the night. Students have to respond as if they’re already interns. Michigan students also meet with current residents and talk about the real-life challenges of internship.

    “I’ve been consistently impressed with the dedication of these fourth-year medical students who choose to do this for their education. I think more and more residency programs will start to expect that their residents have taken part in a program like this.”

    Christian Jones, MD, MS
    Johns Hopkins Medicine

    At the end of the four weeks, with the students’ consent, faculty send a letter to each student’s residency program director detailing the skills they’ve mastered. In an evaluation of the curriculum, published in 2016 in The Clinical Teacher, Morgan and colleagues reported that the courses do improve students’ knowledge and can help bridge the gap between medical school and residency.

    “Residency is such an intense experience,” Morgan said. “These courses help students discover where their strengths are and where they need improvement.”

    While Michigan’s boot camp courses are not required, Morgan said nearly all fourth-year students who were entering an OB/GYN residency voluntarily signed up.

    In Baltimore, Md., at Johns Hopkins Medicine, students who sign up for the surgical boot camp get to practice a variety of clinical skills. But panel discussions with interns on what they wish they had known before residency and with advanced practice providers on what they wish interns knew from the start are unique, according to Jones.

    “I’ve been consistently impressed with the dedication of these fourth-year medical students who choose to do this for their education,” Jones said. “I think more and more residency programs will start to expect that their residents have taken part in a program like this.”