Impact of an end-of-fourth-year emergency medicine bootcamp

Bridging the procedures skill gap from medical school to residency: a simulation-based mastery learning curriculum

BACKGROUND

The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students' procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school.

METHODS

Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores.

RESULTS

Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively.

CONCLUSIONS

Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

Understanding learners' experiences across three major transitions in undergraduate medical education

BACKGROUND

Medical students in the United States undergo three significant transitions as they progress from pre-clinical to clinical rotations, to acting interns, and ultimately to first-year resident. However, there is limited understanding of whether the factors and strategies that impact these transitions remain consistent or are unique to each individual transition.

METHODS

Qualitative data was collected from three Nominal Group Technique (NGT) sessions held separately for third-year students (M3), fourth-year students (M4), and first-year residents (PGY-1). The participants were asked to share their perceptions on their most recent medical school transition. These responses were independently coded into thematic categories.

RESULTS

The NGT session with M3 students (n = 9) identified 67 transition factors and 64 coping strategies. The M4 (n = 8) session identified 33 transition factors and 72 strategies to manage their transition. The PGY-1 (n = 5) session identified 28 factors and 25 strategies. The coping strategies for each session were categorized into seven themes and the transition factors were assigned to ten thematic categories.

CONCLUSION

Just as each transition is unique, so too are the number and variety of factors and strategies to manage each transition. Despite these differences, the themes of "Professional socialization" and "Prioritization, efficiency, and delegation" emerged as impactful in all three transitions.

Pilot Study: Increasing Confidence in Obstetrics and Gynecology Applicants Through a Prep Course Prior to Audition Rotations

Introduction: As more medical schools schedule the United States Medical Licensing Examination (USMLE) Step 1 after the completion of clinical rotations in their curriculum, students are finding themselves increasingly removed from the clinical setting prior to their audition rotations. In the military, these audition rotations are important for matching into competitive specialties, such as Obstetrics and Gynecology (Ob-Gyn). This pilot study explores the confidence and audition readiness of prospective candidates through their participation in an Ob-Gyn preparatory course.

Methods: Rising fourth year medical students applying for an Ob-Gyn residency attended an in-person review session. It consisted of four interactive presentations addressing rotation resources, labor and delivery triage, postpartum care, laparoscopic anatomy review, and concluded with a resident question and answer panel. These attendees completed a pre- and post-course survey on Google Forms. Categorical answers were recorded as response frequency and Likert scales were converted into a 5-point system for analysis.

Results: A 100% response rate from attendees revealed pre-course 81.8% confidence in performing well on an audition rotation with only 27% feeling prepared in terms of their medical knowledge. After completion of the course, all participants reported increased medical knowledge and recommended the course to other students.

Conclusions: Preparatory courses for Ob-Gyn residency candidates can increase confidence and preparedness for audition rotations and, ultimately, internship. As the residency application process becomes more competitive, departments can take steps such as hosting a preparatory course to best assist their students into matching and provide skills that they can practice heading into internship.

Hopes and fears: A qualitative analysis of the intern perspective at the start of EM residency

Objectives

Most emergency medicine (EM) residency programs have orientation curricula to guide interns through the transition from medical school to residency, although no standard components are required. This transition is recognized as a challenging time for young physician learners; however, there is no current understanding of the perspective of incoming interns as they enter residency. We sought to identify themes, examine the current literature, and reflect on the experiences of our residency leadership to inform the creation of orientation activities that foster positive experiences, as well as directly address intern fears and anxieties.

Methods

This qualitative study collected free text responses on the first day of EM orientation regarding areas of high excitement and high fear as interns entered residency. Data were collected from 2011 to 2019 in a 4-year EM residency program and a 6-year combined EM-Anesthesia residency program in the Mid-Atlantic. An inductive approach was used to code intern responses and develop themes within each category, and a frequency analysis was performed.

Results

A total of 112 interns participated. Thematic analysis of coded responses yielded 11 themes around "most excited" and 13 themes around "most scared." The most frequent themes for "most excited" were: (1) Forming new relationships, (2) Building and applying knowledge, and (3) Being responsible for the care and education of others. For "most scared," the most frequent themes were: (1) work-life balance and burnout, (2) making harmful mistakes, and (3) knowledge wealth and retention.

Conclusions

We identified themes of high excitement and high fear for interns entering residency orientation. Based on the themes developed and current literature, recommendations for residency programs regarding intern orientation are provided, specifically that programs intentionally address opportunities for professional identity formation, building relationships with new people/places, emphasizing wellness, and mitigating burnout.