J. A. McClintic1, C. L. Snyder1, K. M. Brown1 1University Of Texas Medical Branch,Department Of Surgery,Galveston, TEXAS, USA
Introduction:
The Accreditation Council for Graduate Medical Education (ACGME) has issued Common Program Requirements to assure patient safety through appropriate intern supervision during the transition from student to doctor. However, there are no established assessment tools to measure readiness for indirect supervision. Traditionally, faculty or senior residents distribute responsibility as they feel appropriate for each junior resident. Boot camps are often used to train interns, but there is a need for valid, standardized tools to assess residents' indirect supervision readiness.
Methods:
Surgical interns (n=21) completed six individual simulations and two team simulations following "intern boot camp". Residents (n=4; PGY-3,4) and third-year medical students (n=27) completed one of the simulations as part of their curriculum. These simulations were scored with the use of checklists. As an additional measure for comparison, surgical faculty and upper level residents overseeing the interns during their first two months were surveyed to evaluate the interns' readiness for indirect supervision. Post "intern boot camp" surveys were also analyzed for interns' views on the assessments.
Results:
All 8 simulations for 21 interns were completed over the course of 2 3-hour sessions with 3 faculty per session. Of the six individual simulations four had complete data for 21 interns. 12 of the interns passed all four stations, 7 failed one of the four stations, and 2 failed three of the four. The interns' mean simulation performance (12.7) was significantly higher than the medical students' mean (10.5) with a p-value of 0.018. When the inters' mean was compared to the PGY-3,4 residents' mean (10.8) there was not a significant difference (p=0.16). The resident and faculty response rate for the survey was low (15%) and showed little correlation (R=-0.22) to the intern’s individual performance. 40% of the respondents were unable to evaluate the intern's ability to manage a patient in cardiac or respiratory arrest and 16% were unable to evaluate the intern's ability to manage critically ill patients. 77% of the intern surveys reported the simulated patient assessments were either valuable or extremely valuable.
Conclusion:
Simulation was able to demonstrate 7 interns with areas of weakness and 2 with serious deficiencies prior to them entering the patient care setting. The resident and faculty surveys also indicated that the traditional methods of observation are not sufficient to evaluate interns in every category of indirect supervision over the period of a month. Simulation offers an efficient means to fulfill the ACGME indirect supervision requirements in a standardized fashion. However, a prospective study with additional institutions is warranted to provide further validity and standardization for simulation as an assessment tool for indirect supervision readiness.