Mock Paging and Consult Curriculum to Prepare Fourth-Year Medical Students for Medical Internship

Assessing readiness: the impact of an experiential learning entrustable professional activity-based residency preparatory course

As medical schools move to integrate the Core Entrustable Professional Activities for Entering Residency (EPAs) into curricula and address the transition from student to resident, residency preparatory courses have become more prevalent. The authors developed an experiential learning EPA-based capstone course for assessment to determine impact on learner self-assessed ratings of readiness for residency and acquisition of medical knowledge. All fourth-year students from the classes of 2018-2020 completed a required course in the spring for assessment of multiple EPAs, including managing core complaints, performing basic procedures, obtaining informed consent, and providing patient handoffs. Learners selected between three specialty-based parallel tracks - adult medicine, surgery, or pediatrics. Students completed a retrospective pre-post questionnaire to provide self-assessed ratings of residency preparedness and comfort in performing EPAs. Finally, the authors studied the impact of the course on knowledge acquisition by comparing student performance in the adult medicine track on multiple choice pre- and post-tests. Four hundred and eighty-one students were eligible for the study and 452 (94%) completed the questionnaire. For all three tracks, there was a statistically significant change in learner self-assessed ratings of preparedness for residency from pre- to post-course (moderately or very prepared: adult medicine 61.4% to 88.6% [p-value < 0.001]; surgery 56.8% to 81.1% [p-value < 0.001]; pediatrics 32.6% to 83.7% [p-value 0.02]). A similar change was noted in all tracks in learner self-assessed ratings of comfort from pre- to post-course for all studied EPAs. Of the 203 students who participated in the adult medicine track from 2019-2020, 200 (99%) completed both the pre- and post-test knowledge assessments. The mean performance improved from 65.0% to 77.5% (p-value < 0.001). An experiential capstone course for the assessment of EPAs can be effective to improve learner self-assessed ratings of readiness for residency training and acquisition of medical knowledge.

Implementation and Evaluation of a Trainee Orientation Manual in an Intensive Care Unit Rotation

Background

The intensive care unit (ICU) rotation places trainees in a fast-paced, high-intensity environment that requires complex patient care and multidisciplinary coordination. Trainees seek continuous medical knowledge acquisition while tasked with learning ICU-specific workflows, procedures, and policies. The unfamiliarity with rotation logistics and administrative roles and expectations could hinder the ICU rotation learning experience. A lack of standardization and material for trainee orientation to administrative ICU tasks and workflows could affect the trainee's rotation performance and overall learner satisfaction.

Objective

We evaluated the implementation of an ICU trainee manual to provide trainees with a source of orientation for rotation logistics and nonclinical ICU tasks. We assessd its impact on content retention, learners' satisfaction with the manual, and overall ICU rotation experience.

Methods

We designed an observational, prospective cohort study that included all trainees scheduled to rotate in the ICU during the 2020-2021 academic year. The ICU manual was delivered electronically and was available throughout the academic year. Trainees received a survey before their first ICU rotation (pretest) and 6 months after their first ICU rotation (retest) to assess content retention, trainees' perception of the ICU manual, and overall rotation satisfaction.

Results

A total of 95 trainees completed the pretest survey, and 61 completed the retest survey. The target cohort response rate for each survey was 100%. Pretest scores were higher than the matched retest scores (41 of 48 [interquartile range, 37-44] vs. 38 of 48 [34-41]; P < 0.001). The median ICU manual satisfaction score was 32 of 40 (26-36.5). We found positive correlations between ICU manual trainee satisfaction score and the retest score (r[59] = 0.320; P = 0.01) and ICU rotation trainee satisfaction level (r[59] = 0.909; P < 0.001).

Conclusion

Implementing an ICU manual to orient trainees to their ICU clinical rotation was well received and showed continued retention of orientation content. Higher ICU rotation trainee satisfaction levels were related to a positive perception of the ICU manual.

Preparing Interns as Teachers: Teaching Fourth-Year Medical Students the Tenets of the One-Minute Preceptor Model

Introduction

Often, interns are expected to teach medical students early in their residency, but most are not formally taught how to be effective teachers before residency. Currently, there is emphasis on developing teaching skills of residents rather than students before they become residents. Most published student-as-teacher courses are voluntary and do not assess skill acquisition.

Methods

We taught 290 fourth-year medical students across two academic years (2020-2022) the tenets of the One-Minute Preceptor (OMP) using a 2-hour workshop during their transition to residency course. A variety of role-play cases allowed students to practice the different parts of the OMP in isolation and combined. Then, we assessed their teaching skills after the workshop using an objective structured teaching exam (OSTE).

Results

Two hundred seventy-eight students (96%) completed the self-assessment of their confidence demonstrating the skills of the OMP before and after the workshop. Their confidence improved in all domains, with ps < .001. Additionally, all students successfully demonstrated competency on the OSTE.

Discussion

We used a 2-hour workshop based on the OMP to improve fourth-year medical students' confidence in their teaching skills and allow them to demonstrate competence in those skills before starting their intern year.

The Art of the Consult Call: Improving Communication Through Shared Mental Models

Introduction

The Accreditation Council for Graduate Medical Education cites effective communication with physicians as a core competency for emergency medicine (EM) residents. However, there is no standardized curriculum dedicated to communication beyond practice in the clinical setting.

Methods

We developed a 1-hour EM didactic session on effective consultations using experiential education principles. Learners were placed in pairs of one junior learner and one senior learner. The junior learner performed a mock phone consultation using an EM patient case; the senior learner completed an online evaluation, assessing the junior learner on 13 core components of a successful consult call, based on Kessler's 5Cs consultation model. Subsequently, learners participated in an intervention, which included an artistic activity and facilitated debrief, connecting their reflections to clinical practice. Postintervention, the same paired learners completed a second mock consultation call and reevaluation. Finally, learners completed a feedback survey.

Results

Fifteen pairs completed both the pre- and postintervention evaluations. Of the junior learners simulating the consultation call, 47% were clinical medical students, and 53% were first-year EM residents. Preintervention, learners completed a mean of 51% of core consult call components compared to a mean of 84% postintervention. This 33% improvement was statistically significant (p < .001; 95% CI, 19.9-46.1). Eight participants completed the feedback survey; 100% agreed or strongly agreed with positive statements regarding overall session content.

Discussion

This engaging interactive session utilizing a mock communication exercise, unique artistic activity, and guided reflection can effectively increase junior learners' phone consultation communication skills.

The Development of a Video Intervention to Improve Senior Medical Students' Performance on Outpatient Telephone Encounters: a Delphi Analysis and Randomized Controlled Trial

Introduction

Postgraduate trainees address outpatient telephone calls (OTCs) with little prior training. This study determines the skills necessary for OTCs and examines whether a video intervention improves medical students' performance on simulated OTCs.

Materials and Methods

We utilized a Delphi technique to determine skills needed for OTCs and created a 9-min video teaching these skills. Senior medical students were randomized to Intervention (viewed video) and Control (did not view video) groups. Students were assessed pre-/post-intervention on simulated OTCs. The primary outcome was the between-group difference in improvement.

Results

The Delphi yielded 34 important skills with the highest focus on communication (n = 13) and triage (n = 6). Seventy-two students completed assessments (Control, n = 41; Intervention, n = 31). The score (mean ± SD) improved 4.3% in the Control group (62.3 ± 14.3% to 66.6 ± 25.0%) and 12.2% in the Intervention group (60.7 ± 15.2% to 72.9 ± 20.4%, p = 0.15). The effect size measured by Cohen's d was 0.55, considered effective (> 0.33) for an educational intervention.

Conclusions

This project fills a gap in OTC training. The use of the Delphi technique, intervention development based on the results, and evaluation of efficacy is a process that could be reproduced for other educational gaps.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-021-01331-w.

Handoffs and Nurse Calls: Overnight Call Simulation for Fourth-Year Medical Students

INTRODUCTION

Interns must be able to give and receive handoffs and use handoff information to respond to calls from nursing staff regarding patient concerns. Medical students may not receive adequate instruction in these tasks and often feel unprepared in this aspect of transitioning to residency. This program simulated an overnight call experience for fourth-year medical students emphasizing handoffs, nurse calls, and medical emergency response.

METHODS

The program utilized a combination of traditional didactics and simulated handoffs, nurse calls, and patient scenarios to allow groups of fourth-year medical students to independently manage a simulated overnight call. The program was designed for students as part of a larger Transition to Residency capstone course.

RESULTS

We ran four sessions over 3 years, with a total of 105 medical student participants. All students reported increased confidence or comfort in their ability to manage handoffs and respond to nurse calls. Students reported that the sessions were helpful and realistic.

DISCUSSION

This program provided fourth-year medical students with a realistic and useful opportunity to simulate handoffs and response to nurse calls, which increased their confidence and comfort. Minor changes were made between iterations of the course with continued positive feedback from medical students. The course is generalizable and can be adapted to the needs and resources of different institutions.

An Interactive Mock Paging Curriculum to Prepare New Internal Medicine Interns for Inpatient Wards

INTRODUCTION

The July effect refers to an increase in adverse outcomes during periods of physician trainee turnover in teaching hospitals. We created an interactive resident-led curriculum to train new internal medicine interns for routine encounters on inpatient wards by role-playing through mock paging scenarios and focusing on practical information relevant to intern year.

METHODS

A formal assessment of the academic year 2018 intern boot camp curriculum revealed that interns preferred sessions that involved active learning strategies and covered common issues. In the first week of academic year 2019, interns participated in two 1-hour small-group sessions involving mock paging scenarios. Interns were divided into small groups with one facilitator who was a senior medicine resident. Within these groups, facilitators acted as the nurse and provided pages. Interns took turns answering these mock pages based on a sign-out of patients. The facilitator emphasized desired learner actions and teaching points using a provided guide.

RESULTS

Twenty interns participated in the curriculum. Interns rated the curriculum highly and felt that the sessions improved their knowledge, comfort, and skills in managing routine inpatient encounters. On a 2-week follow-up knowledge test to determine if they retained the information from the curriculum, interns scored an average of 85% (response rate: 60%, N = 12), indicating that they could apply the knowledge/skills learned to new scenarios.

DISCUSSION

This curriculum prepares medicine interns to manage common inpatient issues at the beginning of their residency. After completing the curriculum, interns reported increased confidence in handling these issues.

Developing a communication curriculum for primary and consulting services

Communication skills are fundamental to effective patient care, and inter-subspecialty communication is frequently identified as a key component of medical education curriculums globally. The team primarily responsible for a patient, the 'primary service', may often request a consult from a specialist, the 'consulting service', for questions of diagnosis, management, or assistance in arranging or performing a procedure or test. Few resources exist to support the development and growth of communication curriculums across primary and consulting services. We provide tips to improve communication across services in patient care and enhance learning for multiple levels of providers. This article provides a guide for the planning and implementation of a communication curriculum and highlights key components for success, based on our experience as teaching faculty on primary and consulting services, at a large academic institution. With the proper collaborations, teaching touch points, specialist consult communication tool, peer coaches, and timely feedback, this course can meet numerous educational and institutional priorities.

A Paging Training Program for a Fourth-Year Internship Readiness Course

INTRODUCTION

New medical interns face a steep learning curve as they must manage complex medical scenarios, many of which they have only seen before in a classroom setting. To ameliorate these challenges, medical schools are increasingly including courses designed to address the transition from student to doctor. One of the biggest challenges for new interns is learning to triage and manage nursing pages, so we designed a mock paging program incorporated within our fourth-year transitions course.

METHODS

We developed a database of clinical scenarios to occur via telephone between a nurse and a medicine intern. Throughout the 2-week course, these cases were administered to 40 fourth-year medical students by Master's level nursing students and nurse evaluators. The nurses used checklists to evaluate medical student management and communication, and at the end of the phone encounter students received immediate feedback. We used an observational prospective design, using a within subjects method with repeated measures.

RESULTS

Data from a total of 216 phone calls were analyzed for 36 students. No statistically significant improvement of checklist scores was observed. Substantial interrater reliability was observed for the four observed cases with a Fleiss-Kappa of .76. Student comments indicated the activity was helpful for preparing them to answer pages.

DISCUSSION

Our paging program offered students the chance to simulate being on call, as well as the opportunity to receive immediate feedback. It did not show improvement in checklists across time. Limitations included a small sample size and few common variables across the cases.

Calling Consults: A Workshop to Teach Trainees Using Both Didactic and Small Group-based Learning

Background: Safe patient care includes effective communication. The Accreditation Council for Graduate Medical Education common program requirements include core requirements for trainees to act in a consultative manner and communicate effectively. However, trainees do not commonly receive formal education on this topic. Objective: We created a 1-hour workshop to teach residents and fellows how to effectively call consults, including how to formulate a cogent and comprehensive consult question. Methods: The workshop, delivered over a 1-hour noon conference, included a didactic portion and interactive small-group case-based learning. We used pre- and postworkshop surveys to assess learners' prior training, knowledge, and comfort levels in calling consults. Subspecialists answered a separate survey about the quality of consults received from trainees before and 30 days after the workshop. Results: Seventy-three trainees attended the workshop (41.2% of total trainees invited). After the workshop, the percentage of learners who identified as very or somewhat comfortable with calling consults increased from 82% to 91%. Before the workshop, 87% of trainees could identify key elements in a consult, which increased to 100% after the workshop. There was not a statistically significant improvement in subspecialists' ratings of the overall quality of consults they received 30 days after the workshop. Conclusion: Training learners on the key components and etiquette of calling consults is crucial for the development of effective communication among providers. This training is generally lacking from undergraduate medical education; thus, it is important to provide education in calling consults during residency and fellowship.