As new residents start their Internal Medicine training in July, many studies have raised concerns about patient safety associated with inexperienced residents, also termed the “July effect.” Based on surveys conducted at our Internal Medicine residency program, there is considerable variation in the inpatient experiences and skills of incoming interns starting residency training. Reviews of recent intern experiences revealed insecurities in communication, cross‐cover, and procedural responsibilities.
We hypothesized that a formal training workshop during resident orientation would improve essential skills needed for inpatient management. A team of hospitalists designed and implemented a rigorous multidisciplinary workshop providing structured training in communication, commonly encountered cross‐cover scenarios, and procedures. To evaluate the impact of this formal training course, intern confidence was measured prior to and after the intervention.
During Internal Medicine resident orientation at Baylor College of Medicine in June 2013, 68 residents participated in a full day training bootcamp divided into three sessions: Procedural training, 8 Cross‐cover case simulations, and Teaching Sessions. The procedural training included hands‐on practice with basic ultrasound techniques, central line placement, and managing a code blue situation. The cross‐cover simulations were done one‐on‐one with common overnight patient issues: chest pain, shortness of breath, altered mental status, hypotension/sepsis, atrial fibrillation with rapid ventricular rate, acute GI bleeding, acute stroke, and headache. The teaching sessions were entitled Art of Handoffs, Art of Floating, Art of Patient Presentations, and Art of Efficient Note Writing.
All residents were sent a pre‐intervention and post‐intervention survey about their self‐reported comfort level with communication skills, procedural skills, and cross‐cover scenarios. There was significant improvement in comfort level for each cross cover scenario: chest pain 3.0 to 4.0, shortness of breath 2.8 to 4.0, altered mental status 2.6 to 3.6, hypotension/sepsis 2.7 to 3.6, atrial fibrillation 2.6 to 3.6, acute GI bleeding 2.4 to 3.7, acute stroke 2.3 to 3.7, and headache 3.1 to 3.8 [n=67, response rate 98.5%, Likert scale 1=very uncomfortable, 5=very comfortable]. Resident self‐reported comfort level with the following procedures also increased: central line placement 1.6 to 2.9, code blue scenario 2.0 to 3.3, and using an ultrasound 2.8 to 3.6 [Likert scale 1=very uncomfortable, 5=very comfortable].
77% strongly agreed and 17% agreed that Bootcamp should be continued for future orientation sessions.
The full day training workshop prior to starting residency significantly improves important inpatient management skills for incoming residents. Hospitalists can lead efforts to design educational interventions for incoming residents. Future directions include improving observed assessment of handoff skills and assessing impact on patient safety.
To cite this abstract:Shah C, Campbell S, Agrawal A, Cunningham L, Kulkarni P, Shah N, Patel K, Hamill R. Improving Inpatient Skills Through a Bootcamp for New Residents. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 191. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/improving-inpatient-skills-through-a-bootcamp-for-new-residents/. Accessed March 31, 2020.