To evaluate interns’ perceived preparedness for defined surgical residency responsibilities and to determine whether fourth-year medical school (M4) preparatory courses (“bootcamps”) facilitate transition to internship.
The authors conducted a multi-institutional, mixed-methods study (June 2009) evaluating interns from 11 U.S. and Canadian surgery residency programs. Interns completed structured surveys and answered open-ended reflective questions about their preparedness for their surgery internship. Analyses include t tests comparing ratings of interns who had and had not participated in formal internship preparation programs. The authors calculated Cohen d for effect size and used grounded theory to identify themes in the interns’ reflections.
Of 221 eligible interns, 158 (71.5%) participated. Interns self-reported only moderate preparation for most defined care responsibilities in the medical knowledge and patient care domains but, overall, felt well prepared in the professionalism, interpersonal communication, practice-based learning, and systems-based practice domains. Interns who participated in M4 preparatory curricula had higher self-assessed ratings of surgical technical skills, professionalism, interpersonal communication skills, and overall preparation, at statistically significant levels (P < .05) with medium effect sizes. Themes identified in interns’ characterizations of their greatest internship challenges included anxiety or lack of preparation related to performance of technical skills or procedures, managing simultaneous demands, being first responders for critically ill patients, clinical management of predictable postoperative conditions, and difficult communications.
Entering surgical residency, interns report not feeling prepared to fulfill common clinical and professional responsibilities. As M4 curricula may enhance preparation, programs facilitating transition to residency should be developed and evaluated.
R.M. Minter is associate chair of education and associate program director, Department of Surgery, associate professor and chief, Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, and associate professor, Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan.
K.D. Amos was, at the time of this research, associate professor, Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
M.L. Bentz is professor and chairman, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
P. Gabler Blair is associate director, Division of Education, American College of Surgeons, Chicago, Illinois.
C. Brandt is the chair and Richard B. Fratianne MD Professor of Surgery, Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
J. D’Cunha was, at the time of this research, associate program director, Division of Thoracic and Foregut Surgery, and assistant professor, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, and is now associate professor and associate director of lung transplantation, associate program director of thoracic surgery, and vice chairman, Academic Affairs, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
E. Davis is education research associate, Division of Education, American College of Surgeons, Chicago, Illinois.
K.A. Delman is associate professor, Department of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
E.S. Deutsch is physician, Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children, Wilmington, Delaware.
C. Divino is professor and chief, Division of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
D. Kingsley is assistant professor, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.
M. Klingensmith is vice chair of education and Mary Culver Distinguished Professor, Department of General Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
S. Meterissian is associate dean, Postgraduate Medical Education, and program director, General Surgery, Department of Medicine, McGill University, Montreal, Québec, Canada.
A.K. Sachdeva is director, Division of Education, American College of Surgeons, Chicago, Illinois.
K. Terhune is assistant professor, Department of Surgery, and assistant professor of anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
P.M. Termuhlen is associate program director and professor, Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
P.B. Mullan is professor, Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, Michigan.
Funding/Support: The American College of Surgeons Division of Education has provided extensive support for this work and for the development and maintenance of the national preparatory curriculum.
Other disclosures: None reported.
Ethical approval: Exemption was obtained from the Loyola University institutional review board.
Previous presentations: Portions of these data have been presented at the following venues: American College of Surgeons Clinical Congress, San Francisco, California, October 2011; Accreditation Council for Graduate Medical Education Annual Educational Conference, Orlando, Florida, March 2, 2012; Association for Surgical Education Meeting, San Diego, California, March 22, 2012; Grand Rounds, Department of Surgery, University of New Mexico, Albuquerque, New Mexico, January 17–18, 2013; Association of Program Directors in Surgery Annual Meeting, Orlando, Florida, April 25, 2013; Grand Rounds, Department of Surgery, Southern Illinois University, Springfield, Illinois, May 15–16, 2013; American Board of Surgery Summit on Pre-Residency Instructional Program, Philadelphia, Pennsylvania, May 31, 2013; and Grand Rounds, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, January 14, 2014.
Correspondence should be addressed to Rebecca M. Minter, 2210A Taubman Center, 1500 E. Medical Center Dr. SPC 5343, Ann Arbor, MI 48109-5343; telephone: (734) 936-7944; e-mail: email@example.com.