“Where simulation ends and training begins” The effect and durability of a pre-graduation prep course for medical students entering surgical training

Abstract

Introduction Medical school does not specifically prepare students for internship. Pre-internship courses are known to increase confidence in multiple key areas. Several prior studies have looked at courses given at the beginning of internship when anxiety is high. We examined the immediate effect and durability of effect of a pre-graduation prep course (PGPC) on provider confidence in medical management and technical skills. Methods A four day simulation PGPC (refer to Table) was offered to medical students (MS) entering surgical programs (n=18; 2009-2010). MS were anonymously surveyed before, after and 6 months following the course. The same survey was given 6 months into internship to a control group of surgical interns who did not have a PGPC prior to graduation. Data was compared between the time intervals and across cases and controls using the Wilcoxon rank-sum and signed-rank tests.Medical Management SkillsTechnical SkillsRespiratory DistressCricothyroidotomyPost-operative FeverChest tubePost-operative BleedingCentral LineOliguriaArterial LineChange in Mental StatusPeripheral LineElectrolyte DisturbancesUrinary CatheterChest PainNasogastric Tube Placement (and) ManagementAcute Deterioration Unknown EtiologyACLS algorithms Results MS (n=12) confidence post-PGPC compared to pre-PGPC improved significantly in all areas except placement of an IV or urinary catheter. Six months into internship there was no difference in confidence levels between the MS PGPC group (n=18) and the controls (n=9), except the MS PGPC group felt more confident in their ability to perform a crichothyroidotomy (2.5 vs 1.4 p=0.04) or place a chest tube (3.3 vs 2.1, p=0.05). Conclusions PGPC can improve self-confidence in young doctors prior to enrolling in surgical residency in many areas of peri-operative care. The effect is most durable in high risk, infrequently performed technical tasks. Future studies are under design to examine the impact of PCs on the July Effect.