Background: The sub-internship is a crucial clinical experience during which students have the opportunity to assume the intern role in preparation for residency. Despite being a nearly universal rotation across institutions, inconsistencies remain in the knowledge and skills taught during this rotation. Many groups in undergraduate and graduate medical education have worked together to establish a set of skills and behaviors expected of all medical school graduates.1 Such skills include recognition of ‘sick vs not sick,’ knowing when to ask for assistance, time management, and interdisciplinary communication. These more practical tasks of internship are not often intentionally taught in more traditional curricula.2 Historically, at our institution, the sub-internship orientation included a thirty minute overview of grading policies and logistics without any significant focus on skills.
Purpose: Fourth year students previously began their sub-internship rotation with a brief orientation. Often, they are returning directly to the clinical wards after a year or more of research. There are practical skills involved in serving as the primary provider for a patient which could be taught in a more in-depth bootcamp orientation. Through this project, we sought to identify skills which were lacking prior to starting the sub-internship rotation in order to develop and implement a combined Internal Medicine and Pediatrics bootcamp curriculum for the 2021 sub-internship season. The project aims were to improve knowledge, confidence, communication, and practical doctoring skills prior to the start of sub-internship.
Description: We began with a baseline retrospective survey of the student experience related to orientation for those who completed Internal Medicine and Pediatrics sub-internships in 2020. This needs assessment evaluated comfort level and preparedness for the rotation. Just over half (59%) of students felt extremely or very well prepared following their brief orientation. We then developed a curriculum of important and relevant sub-intern skills, including: introduction to the EMR, task prioritization and paging, handoff, calling consults, and microaggressions. This curriculum was delivered in a half-day bootcamp format as part of the orientation for all students enrolled in pediatrics and medicine sub-internships in 2021. Immediately prior to and after the bootcamp, we surveyed the students to have them self-assess preparedness in skills taught. These surveys also assessed satisfaction with the curriculum. After the bootcamp, students felt more comfortable calling a consult, being the primary contact for their patient, safely handing off a patient to another provider, prioritizing patient care tasks, and managing their time. Fifty students (79%) who completed the survey felt extremely or very well prepared by the bootcamp prior to starting their sub-internship. There was minimal improvement post-bootcamp with delivering bad news, an area that was not focused on during orientation, as well as less comfort with asking a supervisor for help.
Conclusions: Overall, students felt more prepared for sub-internship following the bootcamp when compared to students who underwent a brief orientation session. Students who participated in the bootcamp demonstrated higher levels of comfort in several domains needed to be a successful sub-intern. Future curriculum development can focus on teaching skills to effectively deliver bad news and how to ask for help, important skills for future physicians.
