In taking a hard look at the shortcomings of new residents, Christian Jones, MD, realized that they were lacking in the so-called soft skills such as time management, effective teamwork, and resiliency and wellness.
“The undergraduate curriculum is still the essence of becoming a physician,” said Dr. Jones, an assistant professor and the assistant surgical residency program director at Johns Hopkins University School of Medicine. “But it tends to concentrate on knowledge base rather than on the skills needed for a surgical residency.”
In an effort to address this skill gap, Hopkins was among the 71 training institutions that recently piloted the Resident Prep Curriculum, a weeklong boot camp for fourth-year medical students who will soon transition to surgical residency. The camp was formulated through a partnership with the American College of Surgeons, Association of Program Directors in Surgery and the Association for Surgical Education.
Medical students and medical faculty view the fourth-year curriculum with the same overarching goal: To create physicians who are ready to practice on day one of their residency. Yet a 2015 study found that interns entering surgical residency reported feeling ill-prepared to “fulfill common clinical and professional responsibilities.”
In light of that, pre-residency programs like the one at Hopkins are growing in popularity, though the methodology may vary. Hopkins’ “boot camp” takes place over five consecutive eight-hour days. The program serves to reinforce learned skills and teach those that may not have been addressed.
“There is a need to recalibrate what is expected of new residents,” said Dr. Jones, also program director of the acute care surgery fellowship at Johns Hopkins. “The knowledge residents are getting in medical school is well beyond what most of us who came through medical school and residency even five or 10 years ago experienced. Unfortunately, there’s so much to learn that some things tend to be overlooked.”
The organizations with which Hopkins has partnered in creating the boot camp have laid out 11 critical skills that will be needed during the first week of residency:
- Being the first responder for critically ill or unstable patients.
- Emergency procedures (ventilation).
- Common electrolyte abnormalities.
- Management of common and urgent perioperative conditions.
- Interpreting radiographs.
- Operative anatomy.
- Responding to pages from nurses.
- Difficult patients.
- Informed consent.
Most of these content areas are technical and, while they are covered during boot-camp sessions, they are not the principal emphasis.
“[Technical skills] are the things that surgeons have concentrated on for a very long time,” Dr. Jones said. “Luckily, that means a lot of our students have taken the time to focus on those things themselves—and what they haven’t necessarily spent a great deal of time working on, or thinking about, are these nontechnical skills.”
Nontechnical skills including time management, effective teamwork, and resiliency and wellness, are the greater focus of the boot camp.
Too many students, Dr. Jones said, are only passingly familiar with the roles played by advanced-practice providers before starting their residency.
“They might have heard of nurse practitioners or physician assistants, but have no idea how they fit into the group,” he said. “We try to concentrate on ... some of those things they don’t tend to come across in medical school, but [which] are much more practical and non-operative based.”
The boot camp is offered on a voluntary basis and participants do not receive class credit. About 75 percent of those eligible have taken part.
Dr. Jones believes programs like the one at Hopkins can be instrumental in shaping the transition from medical school to residency. For too long, he said, residency program directors have made too many assumptions about their incoming interns—to the detriment of their early training.
“It is assumed that residents already have good study habits, that residents have good time-management skills, that residents have a good capability for teamwork. I don’t think we need to expect less of our residents,” Dr. Jones said. Rather, it is up to medical educators to help “ensure that they have the opportunity to make up for whatever deficiencies they may have.”