A concept that has been percolating in the medical
literature boiled over into the mainstream as the New York Times published this
story, "Chicago's Intern 'Boot Camp' is a rehearsal for life or death
medical issues."
The article describes a new internal medicine intern having
to deal with a simulated patient who is critically ill and has alarms going off.
Another intern had to tell a "patient" played by
an actor that he had terminal cancer.
The performances of both of the young doctors were evaluated
by instructors. The 81 interns in the program must "pass graded tests
in procedures and communication skills before being allowed to move ahead."
The boot camp described in the Times piece was the
subject of a paper published in Academic Medicine earlier this year. It
concluded that "Boot-camp-trained interns all eventually met or exceeded
the MPS [minimum passing standard] and performed significantly better than
historical control interns on all skills (P < .01), even after controlling
for age, gender, and USMLE Step 1 and 2 scores (P < .001)."
Here
is how the Mayo Clinic describes its boot camp for fourth year med students,
"An intensive 1-week course, Internship Boot Camp has simulated,
longitudinal patient-care scenarios that use high-fidelity medical simulation,
standardized patients, procedural task trainers, and problem-based learning to
help students apply their knowledge and develop a framework for response to the
challenges they will face as interns."
They compared survey results from students who had done the
boot camp to those who had not and found the boot camp prepared students for
internship better than conventional sub-internships did.
Similar "boot camps" are being held in many
surgical residencies.
At the University of Connecticut, surgical interns undergo
"a 2-month (July and August 2011) boot camp curriculum consisting of two
2½-hour knowledge-based and procedural skills (SimMan) didactic sessions per
week and completion of 25 core intensive introductory American College of
Surgeons Fundamentals of Surgery web-based self-study modules, followed by a
standardized patient clinical skills assessment."
At Baystate Medical Center in Massachusetts new
trainees are taught essential skills in patient care and procedures. Over the
four year period during which interns experienced the boot camp, "Individual
simulation-based Boot Camp performance scores for cognitive and procedural
skills assessments in PGY-1 residents [interns] correlate with subjective and
objective clinical performance evaluations."
The Department of Surgery at the University ofPennsylvania holds a boot camp for senior students interested in surgical
career. The introduction to the abstract describing the program says, "Medical
school does not specifically prepare students for surgical internship."
It appears that boot camps are both necessary and effective.
I have one question. Why can't "boot camp" skills
be taught in all medical schools?
