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Never trust an intern in July
How prepared are your interns to take calls? Results of a multi-institutional study of simulated pages to prepare medical students for surgery internship.  Frischknecht AC et al.  The American Journal of Surgery (2014) 208, 307-315


What was the study question?
Does a mock page curriculum for senior medical students improve their preparedness to take calls as interns?

How was the study done?
150 senior medical students enrolled in a 4 week senior surgical intern preparedness elective in 5 institutions were taught a mock page curriculum.  The curriculum consisted of a 90 minute training session at the start of the elective.  A team of surgeons, residents, nurses and medical education experts developed 14 cases that they thought that were representative of typical intern calls and that targeted a specific communication challenge.   7 nurses and 2 standardized patients called the students at random times while they were on call.  After completion of the call, they called the students again and gave feedback.  In addition, all students participated in a weekly group debriefing session.  Participants completed pre and post-course surveys assessing confidence and anxiety.  A control group of 27 new surgical interns who did not participate completed 3 of the cases.

What were the results?
Post-course confidence improved and anxiety decreased in participants.  Average clinical decision making scores were below 50% with failures occurring 31-71% of the time.  Participants demonstrated superior clinical decision making compared to controls in the 3 shared cases.

What are the implications? 
New interns may not be prepared to respond to common pages. Increased supervision may be required at the start of the year. Interventions may be important during orientation.  The mock page curriculum may also be used to assess intern performance and identify areas requiring remediation.

Editor’s Note: While the curriculum did seem to improve confidence and performance, the overall performance was still poor.  Unless we start giving students more practice in medical school, taking call may not be an entrustable professional activity until well into the intern year. (JG)

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