Intern Boot Camp: My First Patient Experience

Editor’s Note: This is the second post from an intern who participated in Northwestern University’s intern boot camp, reported on in  Academic Medicine’s February issue. You can read the first post here.

By Bruce Henschen, MD/MPH, Internal Medicine Resident, Northwestern University McGaw Medical Center

On the hospital bed in front of me sat a woman with labored breathing. It was my first month as a doctor, and the woman, my patient, was suffering from a pleural effusion that required a thoracentesis. With my ultrasound in hand, and my senior resident guiding me through the steps, I sterilized the field, prepared my kit, and inserted the needle, returning straw colored fluid. Because I had practiced those techniques of ultrasound-guided procedures in a safe environment just a few weeks prior, I felt confident in my knowledge of the procedure and in my ability to care for this patient.

A few days later, my patient developed acute hypoxemic respiratory failure and required intubation and mechanical ventilation. The equipment was not as intimidating as it might have been had I not had the opportunity to familiarize myself with it during a practical skills session. Soon, I found myself sitting with members of the family as we discussed the patient’s prognosis, code status, and end-of-life wishes. Having heard these conversations before in medical school I was familiar with their gravity, but during the intern bootcamp I had developed a method of approaching difficult conversations. My colleagues and I updated the family on the patient’s current health and asked them what they thought the patient would have wanted if she was able to make her own decisions. What ensued was a somber but meaningful discussion about the patient’s life, experiences, and preferences. We listened to the family closely and tried to guide them through difficult choices. Through the course of many discussions over the next few days, we decided together to withdraw care. While our decision was emotional, we all believed that it was made in accordance with the patient’s wishes.

My experiences in the intern bootcamp helped me prepare for these first experiences as a doctor. The practical teaching elements in procedures, ICU management, and difficult conversations helped me learn important skills that I needed to know on day 1. Just as valuable was the opportunity to be immersed in a training experience with new colleagues where we learned to trust one another. We worked in a comfortable, collegial, and professional environment, each of us with the goal to prepare ourselves for lives as interns. Through the feedback given to me by my future colleagues, I learned ways to improve my clinical skills and gained confidence in my ability to practice safe patient care. More importantly, I learned that I could rely on my fellow interns for honest feedback and support. In the treatment of my patient above, and many others since, I found myself grateful for the training in practical skills, and trust in my colleagues, that I had developed during the bootcamp.

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  1. Intern Boot Camp: Preparing Residents for Practice « AM Rounds
    February 21, 2013 at 5:23 PM

    […] Editor’s Note: This is the first post from an intern who participated in Northwestern University’s intern boot camp, reported on in  Academic Medicine’s February issue. You can read the second post here. […]

  2. Kemi Tomobi
    February 21, 2013 at 10:52 PM

    Thank you for sharing. It shows that great mentorship can go a long way in medical training, and not enough people take mentorship and positive peer pressure (positive team dynamics) seriously.  I like how you differentiate the gains from simulation training (building confidence in skills) as separate from better communication, because I think that the more important indicator of patient safety is not simulation training, but open communication between providers, and between providers and patients. Anything that improves the lines of communication will improve patient safety. I am glad that you gained a lot already.  Best wishes with the rest of your training.