title: An immersive "simulation week" enhances clinical performance of incoming surgical interns improved performance persists at 6 months follow-up.
abstract: BACKGROUND
  The transition from student to intern can be challenging. The "August" or "July effect" describes increased errors and reduced patient safety during this transition. The study objectives were to develop, pilot, and evaluate clinical performance after an immersive simulation course for incoming interns.
  
  
  METHODS
  Graduating students were recruited for a 1-week immersive simulation course. Controls received no simulation training. Primary outcome (at baseline, and 1 and 6 months) was clinical performance on Objective Structured Clinical Examinations (OSCE) of clinical procedures and surgical technical skills. Secondary outcomes were self-reported confidence and clinical procedure logbook data.
  
  
  RESULTS
  Nineteen students were recruited. Sixteen completed the 6-month follow-up, 10 in the intervention group and 6 in the control group. No differences were demonstrated between interventions and controls at baseline (OSCE [median, 66 vs. 78; P = .181], technical skills [48 vs. 52.5; P = .381], and confidence [101 vs 96; P = .368]). Interventions outperformed controls at 1 month (OSCE [111 vs 82; P = .001], technical skills [78.5 vs 63; P = .030], and confidence [142 vs. 119; P < .001]), and 6 months (OSCE [107 vs. 93; P = .007], technical skills [92.5 vs. 69; P = .044], and confidence [148 vs. 129; P = .022]). No differences were observed in numbers of clinical procedures performed at 1 (P = .958), 4 (P = .093), or 6 months (P = .713).
  
  
  CONCLUSIONS
  The immersive simulation course objectively improved subjects' clinical skills, technical skills, and confidence. Despite similar clinical experience as controls, the intervention group's improved performance persisted at 6 months follow-up. This feasible and effective intervention to ease transition from student to intern could reduce errors and enhance patient safety.
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK. Electronic address: pritam.singh@imperial.ac.uk.
authors: Pritam
authors: P
authors: Singh
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK; Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada.
authors: Rajesh
authors: R
authors: Aggarwal
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK.
authors: Philip H
authors: PH
authors: Pucher
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors: Daniel A
authors: DA
authors: Hashimoto
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK; Centre for Surgical Training & Research, University of Mediterrannee, Marseille, France.
authors: Laura
authors: L
authors: Beyer-Berjot
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK.
authors: Rasiah
authors: R
authors: Bharathan
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK.
authors: Katherine E
authors: KE
authors: Middleton
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK.
authors: Joanne
authors: J
authors: Jones
authors: Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK.
authors: Ara
authors: A
authors: Darzi
mesh_terms: D002983:Clinical Competence; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D061214:Patient Safety; D016544:Patient Simulation
references: Ann Surg. 2005 Jan;241(1):1-8
references: 15621984
references: Ann Surg. 2003 Aug;238(2):291-300
references: 12894024
references: Am J Surg. 2004 Jun;187(6):695-7
references: 15191859
references: Med J Aust. 2004 Oct 4;181(7):357-60
references: 15462649
references: Qual Saf Health Care. 2004 Oct;13 Suppl 1:i27-32
references: 15465952
references: Br J Surg. 1997 Feb;84(2):273-8
references: 9052454
references: Ann Surg. 2014 Feb;259(2):215-21
references: 23470580
references: Am J Surg. 2005 Jul;190(1):137-40
references: 15972187
references: J Surg Res. 2006 Jun 1;133(1):11-5
references: 16580692
references: Curr Surg. 2006 Jul-Aug;63(4):264-8
references: 16843778
references: J Am Coll Surg. 2008 May;206(5):897-904; discussion 904-7
references: 18471719
references: Br J Surg. 2009 Sep;96(9):1086-93
references: 19672934
references: PLoS One. 2009;4(9):e7103
references: 19774078
references: Surgery. 2011 Jun;149(6):745-9
references: 21236456
references: Ann Intern Med. 2011 Sep 6;155(5):309-15
references: 21747093
references: Am J Surg. 2011 Dec;202(6):713-8; discussion 718-9
references: 22019283
references: J Surg Educ. 2012 Mar-Apr;69(2):242-8
references: 22365874
references: Am J Surg. 2013 Aug;206(2):269-79
references: 23433887
references: Lancet. 2012 Aug 4;380(9840):459
references: 22870510
references: J Surg Educ. 2012 Jul-Aug;69(4):536-43
references: 22677594