title: Making July safer: simulation-based mastery learning during intern boot camp.
abstract: OBJECTIVE
  Patient care quality worsens during academic year turnover. Incoming interns' uneven clinical skills likely contribute to this phenomenon, known as the "July effect." The aim of this study was to evaluate the impact of a simulation-based mastery learning (SBML) boot camp on internal medicine interns' clinical skills.
  
  
  METHODS
  This was a cohort study of an SBML intervention at Northwestern University. In 2011, 47 interns completed boot camp; 109 interns (from 2009 and 2010) who did not participate in boot camp were historical controls. Boot-camp-trained interns participated in three days of small-group teaching sessions, deliberate practice, and individualized feedback. Primary outcome measures were performance of boot-camp-trained interns and historical controls on five parts of a clinical skills examination (CSE). Assessments included recognition of physical examination findings (cardiac auscultation), performance of procedures (paracentesis and lumbar puncture), management of critically ill patients (intensive care unit skills), and communication with patients (code status discussion). Boot camp participants were required to meet or exceed a minimum passing standard (MPS) before beginning their internship.
  
  
  RESULTS
  Boot-camp-trained interns all eventually met or exceeded the MPS and performed significantly better than historical control interns on all skills (P < .01), even after controlling for age, gender, and USMLE Step 1 and 2 scores (P < .001). The authors detected no relationship between CSE scores and age, gender, prior experience, self-confidence, or USMLE Step 1 and 2 scores.
  
  
  CONCLUSIONS
  An SBML boot camp allows for individualized training, assessment, and documentation of competence before interns begin providing medical care.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Barsuk
authors.forename: Farzad
authors.initials: F
authors.lastname: Moazed
authors.forename: Timothy
authors.initials: T
authors.lastname: Caprio
authors.forename: Aashish
authors.initials: A
authors.lastname: Didwania
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
mesh_terms: D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D003479:Curriculum; D005260:Female; D006801:Humans; D007087:Illinois; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D016014:Linear Models; D008297:Male; D015588:Observer Variation; D061214:Patient Safety; D016544:Patient Simulation; D012621:Seasons