Abstract

Background

Throughout their medical education, learners face multiple transition periods associated with increased demands, producing stress and concern about the adequacy of their skills for their new role.

Objective

We evaluated the effectiveness of boot camps in improving clinical skills, knowledge, and confidence during transitions into postgraduate or discipline-specific residency programs.

Methods

Boot camps are in-training courses combining simulation-based practice with other educational methods to enhance learning and preparation for individuals entering new clinical roles. We performed a search of MEDLINE, CINAHL, PsycINFO, EMBASE, and ERIC using boot camp and comparable search terms. Inclusion criteria included studies that reported on medical education boot camps, involved learners entering new clinical roles in North American programs, and reported empirical data on the effectiveness of boot camps to improve clinical skills, knowledge, and/or confidence. A random effects model meta-analysis was performed to combined mean effect size differences (Cohen's d) across studies based on pretest/posttest or comparison group analyses.

Results

The search returned 1096 articles, 15 of which met all inclusion criteria. Combined effect size estimates showed learners who completed boot camp courses had significantly “large” improvements in clinical skills (d = 1.78; 95% CI 1.33–2.22; P < .001), knowledge (d = 2.08; 95% CI 1.20–2.96; P < .001), and confidence (d = 1.89; 95% CI 1.63–2.15; P < .001).

Conclusions

Boot camps were shown as an effective educational strategy to improve learners' clinical skills, knowledge, and confidence. Focus on pretest/posttest research designs limits the strength of these findings.

Abstract

Background

Concerns about duty hour and resident safety have fostered discussion about postshift fatigue and driving impairment.

Objective

We assessed how converting to a night float schedule for overnight coverage affected driving safety for trainees.

Methods

Brake reaction times were measured for internal medicine and orthopaedic surgery resident volunteers after a traditional 28-hour call shift and after a night float shift. We conducted matched paired t tests of preshift and postshift reaction time means. Participants also completed the Epworth Sleepiness Scale pre- and postshift.

Results

From June to July 2013, we enrolled 58 interns and residents (28 orthopaedic surgery, 30 internal medicine). We included 24 (41%) trainees on night float rotations and 34 (59%) trainees on traditional 28-hour call shifts. For all residents on night float rotations, there was no significant difference pre- and postshift. An increase in reaction times was noted among trainees on 28-hour call rotations. This included no effect on reaction times for internal medicine trainees pre- and postshift, and an increase in reaction times for orthopaedic trainees. For both night float and traditional call groups, there were significant increases in the Epworth Sleepiness Scale.

Conclusions

Trainees on traditional 28-hour call rotations had significantly worse postshift brake reaction times, whereas trainees on night float rotations had no difference. Orthopaedic trainees had significant differences in brake reaction times after a traditional call shift.

Abstract

Background

Physicians' perceptions of duty hour regulations have been closely examined, yet patient opinions have been largely unstudied to date.

Objective

We studied patient perceptions of residency duty hours, fatigue, and continuity of care following implementation of the Accreditation Council for Graduate Medical Education 2011 Common Program Requirements.

Methods

A cross-sectional survey was administered between June and August 2013 to inpatients at a large academic medical center and an affiliated community hospital. Adult inpatients on teaching medical and surgical services were eligible for inclusion in the study.

Results

Survey response rate was 71.3% (513 of 720). Most respondents (57.1%, 293 of 513) believed residents should not be assigned to shifts longer than 12 hours, and nearly half (49.7%, 255 of 513) wanted to be notified if a resident caring for them had worked longer than 12 hours. Most patients (63.2%, 324 of 513) believed medical errors commonly occurred because of fatigue, and fewer (37.4%, 192 of 513; odds ratio, 0.56; P < .01) believed medical errors commonly occurred as a result of transfers of care. Given the choice between a familiar physician who “may be tired from a long shift” or a “fresh” physician who had received sign-out, more patients chose the fresh but unfamiliar physician (57.1% [293 of 513] versus 42.7% [219 of 513], P < .01).

Conclusions

In a survey about physician attributes relevant to medical errors and patient safety, adult inpatients in a large and diverse sample reported greater concern about fatigue and working hours than about continuity of care.

Having “proficient” teaching faculty has been identified as a cornerstone of resident education in quality improvement and patient safety (QI/PS),1–3 yet a practical definition of “QI/PS proficiency” is lacking.

A working group of experts on faculty development and QI/PS at the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) completed “Quality Improvement and Patient Safety Milestones for the Continuum of Physician Development” to address these deficiencies. We designed our instrument with 2 primary objectives:

To answer the question, “What does proficient in QI/PS look like?” Clinical Learning Environment Review (CLER) site visitors are

Introduction: Formative assessment requires effective feedback. Recent studies have demonstrated the importance of considering the learner's perspective as a determinant of feedback effectiveness.

Objective: We examined factors affecting residents' perceptions of the credibility of their examiners/feedback providers during a formative OSCE, including examiner demographics.

Methods: Following a formative 5-station internal medicine OSCE, residents were randomized to receive feedback with or without scores, and then asked to fill a questionnaire rating the credibility of feedback providers on their final station. Feedback was provided by clinical faculty or standardized patients (SPs). Residents also rated the quality and characteristics of