Why Are There Intern “Boot Camps”?

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 flashing.

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 4 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 of Pennsylvania 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.”

There is talk of shortening medical school to 3 years. Does it sound like graduating students would be ready for residency after 3 years?

I have one more question. Why can’t we just teach “boot camp” skills during medical school?

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1000 page views per day, and he has over 7000 followers on Twitter.