Background: The transition from medical student to intern presents a major patient safety concern. Incoming interns must understand the specific culture of safety at their new institution and processes that they are expected to perform on day 1 of residency without direct supervision. We developed an immersive, integrated First Night On Call (FNOC) simulation to support incoming interns as they transition into new roles in our community. FNOC was designed to address common patient safety issues and create a Culture of Safety.

Methods: FNOC is 4-hour immersive simulation where groups rotated through authentic scenarios including: 1) A 3-station Group Objective Standardized Clinical Experience where learners were exposed to diverse opportunities to practice using a handoff model, escalating an emergent situation to their supervisor or calling the Rapid Response Team, and reporting medical errors, 2) Addressing common patient safety hazards, and 3) Participating in safety rounds with an institutional leader. Learners completed a pre-FNOC assessment, and a retrospective pre-post assessment.

Results: 145 incoming interns from 56 medical schools and 7 departments completed FNOC. Despite 61% (n=145) reporting to have witnessed a medical error during medical school, only 35% reported any formal training in patient safety. Post FNOC more than 94 % of interns reported increased comfort (4 or 5 on 1-5 scale) in speaking to a supervisor, escalating a situation, and reporting a medical error. 63% of groups (n=46) called a rapid response team for the decompensating patient and only 22% contacted the senior resident, 70% of groups (n=44) recognized the label error for the blood cultures and only 33% alerted the nurse, and 67% (n=46) groups confirmed that the consent could take place in the presence of another adult in the room. Almost all of the interns (N=133) agreed or strongly agreed FNOC was an effective way to learn patient safety (99%), a good approach to improve readiness (96%), fun (93%), and engaging (100%).

Conclusions: A large scale, high quality experiential patient safety simulation is a feasible and acceptable approach to engage learners and increase comfort prior to starting internship. Lasting impact will be evaluated by follow-up assessments, as well as a review of patient safety data across our clinical enterprise.