title: Transition to surgical residency: a multi-institutional study of perceived intern preparedness and the effect of a formal residency preparatory course in the fourth year of medical school.
abstract: OBJECTIVE
  To evaluate interns' perceived preparedness for defined surgical residency responsibilities and to determine whether fourth-year medical school (M4) preparatory courses ("bootcamps") facilitate transition to internship.
  
  
  METHODS
  The authors conducted a multi-institutional, mixed-methods study (June 2009) evaluating interns from 11 U.S. and Canadian surgery residency programs. Interns completed structured surveys and answered open-ended reflective questions about their preparedness for their surgery internship. Analyses include t tests comparing ratings of interns who had and had not participated in formal internship preparation programs. The authors calculated Cohen d for effect size and used grounded theory to identify themes in the interns' reflections.
  
  
  RESULTS
  Of 221 eligible interns, 158 (71.5%) participated. Interns self-reported only moderate preparation for most defined care responsibilities in the medical knowledge and patient care domains but, overall, felt well prepared in the professionalism, interpersonal communication, practice-based learning, and systems-based practice domains. Interns who participated in M4 preparatory curricula had higher self-assessed ratings of surgical technical skills, professionalism, interpersonal communication skills, and overall preparation, at statistically significant levels (P < .05) with medium effect sizes. Themes identified in interns' characterizations of their greatest internship challenges included anxiety or lack of preparation related to performance of technical skills or procedures, managing simultaneous demands, being first responders for critically ill patients, clinical management of predictable postoperative conditions, and difficult communications.
  
  
  CONCLUSIONS
  Entering surgical residency, interns report not feeling prepared to fulfill common clinical and professional responsibilities. As M4 curricula may enhance preparation, programs facilitating transition to residency should be developed and evaluated.
authors.affiliation: R.M. Minter is associate chair of education and associate program director, Department of Surgery, associate professor and chief, Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, and associate professor, Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan. K.D. Amos was, at the time of this research, associate professor, Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina. M.L. Bentz is professor and chairman, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin. P. Gabler Blair is associate director, Division of Education, American College of Surgeons, Chicago, Illinois. C. Brandt is the chair and Richard B. Fratianne MD Professor of Surgery, Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. J. D'Cunha was, at the time of this research, associate program director, Division of Thoracic and Foregut Surgery, and assistant professor, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, and is now associate professor and associate director of lung transplantation, associate program director of thoracic surgery, and vice chairman, Academic Affairs, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. E. Davis is education research associate, Division of Education, American College of Surgeons, Chicago, Illinois. K.A. Delman is associate professor, Department of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia. E.S. Deutsch is physician, Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children, Wilmington, Delaware. C. Divino is professor and chief, Division of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. D. Kingsley is assistant professor, Department of Surgery, University of New Mexico School
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Minter
authors.forename: Keith D
authors.initials: KD
authors.lastname: Amos
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bentz
authors.forename: Patrice Gabler
authors.initials: PG
authors.lastname: Blair
authors.forename: Christopher
authors.initials: C
authors.lastname: Brandt
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Davis
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Deutsch
authors.forename: Celia
authors.initials: C
authors.lastname: Divino
authors.forename: Darra
authors.initials: D
authors.lastname: Kingsley
authors.forename: Mary
authors.initials: M
authors.lastname: Klingensmith
authors.forename: Sarkis
authors.initials: S
authors.lastname: Meterissian
authors.forename: Ajit K
authors.initials: AK
authors.lastname: Sachdeva
authors.forename: Kyla
authors.initials: K
authors.lastname: Terhune
authors.forename: Paula M
authors.initials: PM
authors.lastname: Termuhlen
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Mullan
mesh_terms: D002170:Canada; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D004504:Education, Medical, Undergraduate / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D014481:United States