A simulated “Night-onCall” to assess and address the readiness-for-internship of transitioning medical students

Kalet et al. Advances in Simulation (2017) 2:13 DOI 10.1186/s41077-017-0046-1 INNOVATION Open Access A simulated “Night-onCall” to assess and address the readiness-for-internship of transitioning medical students Adina Kalet2,3,6,9,10,11* , Sondra Zabar10,11,3, Demian Szyld4, Steven D Yavner7, Hyuksoon Song8, Michael W Nick6, Grace Ng2, Martin V Pusic1,3, Christine Denicola10,11, Cary Blum10, Kinga L Eliasz6, Joey Nicholson5 and Thomas S Riles2,3,6,9 Abstract Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competencybased, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic “night on call” experience for near graduating students and build measurements of students’ readiness for this transition framed by the Association of American Medical College’s Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education. Keywords: Transitions to residency, Immersive simulation, Mixed modality experiences, Educational experience, Team work, Basic clinical skills, Communication between team members, Handoffs, Oral presentations, Readiness-for-internship assessments, Competency-based medical education, Entrustable Professional Activities Introduction “It still doesn’t quite feel like I am able to jump in and start on July 1…the nurses expect you to be the doctor, the patients expect you to be the doctor, your colleagues expect you to be the doctor”. ~4th year medical student 2 weeks before graduation expressing anxiety about transitioning to residency. “We get to see July 1st as medical students and get to see how a lot of Interns really struggle with some basic skills”. ~3rd year medical student a year before graduation voicing concern about transitioning to residency. * Correspondence: Presented at NEGEA 2016, Providence RI, and the annual national AAMC meeting, Baltimore, Maryland 2015 2 New York Simulation Center for the Health Sciences, New York, New York, USA 3 Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA Full list of author information is available at the end of the article Medical students transitioning from undergraduate medical education (UME) to graduate medical education (GME, also referred to as “residency” or “internship”) experience uncertainty and distress about their readinessfor-internship [1–3]. This lack of readiness may be partially responsible for the “July effect”—a reported increase of 10% in fatal medical errors in teaching hospitals in North America when these new graduates enter the workforce each July [4]. Residency program directors are just as anxious about integrating the incoming medical students into a fast-paced and complex health care system because they are aware that clinical experience and competence during the senior year of medical school is variable, both within a single school and across institutions [5–7], and a new resident class is typically made up of graduates of many medical schools. This heterogeneity in readiness has led residency programs and hospital leadership to implement © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kalet et al. Advances in Simulation (2017) 2:13 orientation programs and increase supervision to ensure patient care quality and safety as new trainees learn to function effectively in their latest roles [8, 9]. Some medical schools have also implemented transition courses; however, these are generally focused by clinical discipline [10]. A clinical discipline-agnostic readiness-for-internship program, administered just prior to medical school graduation, would serve many important purposes including (1) preparing near-graduate medical students for a smooth and safe transition to residency, (2) building an assessment program with the intention of ultimately benchmarking and reporting readiness-for-internship metrics, regardless of clinical discipline, and (3) providing a meaningful educational handoff between UME and GME in the USA and beyond. A competency-based readiness-for-internship assessment program is both timely and critical to the UMEGME continuum [10].In recent years, patient safety and quality assurance committees of hospitals and residency program directors have been called upon by accrediting agencies, malpractice insurance companies, and the general public to demonstrate that trained residents are capable of providing the level of care for which they have been assigned. Residency Review Committees, the clinical discipline specific accreditation bodies of the US Accreditation Council for Graduate Medical Education (ACGME), have provided guidelines outlining what a first-year resident can and cannot do without direct supervision until competency has been documented [11]. In 2014, the Association of American Medical Colleges (AAMC), responsible for accrediting medical schools in the USA, released a set of 13 core Entrustable Professional Activities (EPAs) for entering residency (Core EPAs) (see Fig. 1). EPAs are units of professional practice a trainee can be trusted to accomplish unsupervised once he or she has demonstrated sufficient and specific competence. Authors of the core EPAs provided detailed guidance meant to drive the community toward refining, measuring, and benchmarking the minimal level of competence expected of a medical school graduate [12]. As of yet, there is little consensus on how to assess the Core EPAs of new residents or what type of transition documentation (or “handoff”) to residency programs would be meaningful [13, 14]. Although ensuring readiness-for-inter (...truncated)