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.
By Jeremiah Wasserlauf, MD, resident in internal medicine, Northwestern University Feinberg School of Medicine
When I began residency, I expected clinical procedures to intimidate me. I imagined that I would be taught by a resident one or two years my senior. I would try to focus on the techniques at hand among the competing demands of my numerous sick patients, work hour restrictions, and educational duties. I planned that I would build on my initial experiences through repetition, in the hope that practice makes perfect. This is the way doctors have learned for generations, but is there a better way?
I think back to an early experience from intern year, my first “procedure:” leading a discussion about goals of care. I had recently diagnosed a patient with metastatic cancer. I sat down with her and her family and asked them what they understood about their loved one’s illness. After hearing their perspective, I shared pertinent medical information and focused on learning what their expectations and priorities were. The discussion was challenging but also natural and conversational. It was structured as if I had led such a meeting before. In fact, I had.
Before starting my residency, I participated in Northwestern’s intern boot camp, where incoming residents are given a mission to learn important clinical skills and put them into practice in a simulation lab. We are divided into small groups precepted by chief residents and seasoned attendings. The skills range from code status discussions to ventilator management to lumbar puncture and paracentesis. After learning the techniques, we are tested and given feedback. If there are gaps in our performance, we go back at it until we have mastered it.
In this month’s issue of Academic Medicine, Cohen and colleagues demonstrate that simulation-based mastery learning improves intern confidence, clinical skills, and reduces variation. As a past participant, I can attest that this format gave me the opportunity to learn common procedures and skills in a controlled setting from teachers with experience. While the methods I learned did not apply identically to every patient, they provided a framework to methodically approach complex patient situations, such as the code status discussion I had with my patient and her family. To borrow from Vince Lombardi, “Practice does not make perfect. Only perfect practice makes perfect.” I believe this approach has enriched my education and improved the safety and comfort of my patients.