K. F. Angell1, Z. Senders1, J. T. Brady1, J. Ammori1, J. M. Marks1 1University Hospitals Cleveland Medical Center,Surgery,Cleveland, OH, USA
Introduction: The transition from medical student to surgical intern is a challenging step, encompassing the use of new skills, new clinical sites, utilizing electronic medical records (EMR) systems and providing care for patients while supervising residents may be in the operating room. Surgical orientations covering a multitude of topics have been developed to prepare interns for this transition. Based on our previous orientation surveys, 83% of interns felt a shadowing experience would be very beneficial to internship preparation. We sought to implement a shadowing experience as part of intern orientation to simulate their clinical rotations and best prepare interns with the skills and knowledge required to be a successful intern. Our objective was to assess all orientation activities with a focus on the shadowing experience.
Methods: 15 incoming surgical interns participated in a preparatory orientation preceding the start of internship. Orientation activities included sessions on handoff skills, EMR use, administrative tasks, troubleshooting tubes and drains, surgical instruments and suturing. An optional activity was added for interns to shadow the surgical team on which they would start their internship. Interns participating in the shadowing experience met at one of three hospital rotation sites, attended morning rounds and observed current interns completing daily tasks. Surveys assessing the value of orientation sessions in preparing for internship were administered to all participating interns 6 weeks after beginning internship.
Results: 13 of 15 incoming surgical interns participated in the shadowing session. The following sessions were assessed for usefulness: site tours, handoff practice, suturing and surgical instrument identification, tubes and drains management and general orientation. The tubes and drains lab and overall orientation were rated as most helpful, while surgical instrument labs and site tours rated as least helpful. The shadowing experience was rated ‘helpful’ by 6 of the participants and ‘very helpful’ by the remaining 7 participants. Comments reported shadowing as more valuable than EMR courses in learning EMR use, and multiple interns requested additional shadowing experiences.
Conclusion: The challenge of preparing incoming surgical interns for the transition to internship remains an area for continued improvement. Replicating the tasks required of surgical interns and covering key topics necessary for starting internship is an overwhelming task. A shadowing experience with surgical teams prior to the first day of internship may be a valuable and feasible experience that best exposes incoming interns to the tasks, knowledge and routine of surgical internship. This experience could easily be replicated at any surgical residency program. Surveying additional metrics may provide information to structure the shadowing experience to increase value and positively impact patient safety and workflow.