Hidden Solutions in Obstetrics: A Research Roundup

Welcome to our fifth and final part of our ‘Hidden Threats’ series, where we summarized some of the latest research regarding medical errors and structural issues that can impact the quality of patient care, both in obstetrics and in medicine generally. Every two weeks, we provided a short summary of the latest trends, research articles and news that patients may want to know about the way they get their healthcare. After several weeks of reporting on potential sources of concern within the practice of medicine generally and obstetrics specifically, today we’ll be bringing you some research about one (partial) proposed solution to the July effect: Resident Bootcamp.

Stressful Graduation from Medical School to Residency

The time period between medical school and acclimatization to residency is a stressful one for students first entering medical practice. This time is one of steep learning curves and inefficiencies that impact patient safety, efficiency and duty hours (1). Inexperienced residents care for patients even as they are unfamiliar with their hospital’s and unit’s procedures and protocols, increasing the risk of medical errors that may prove harmful or fatal. Indeed, analysis of medical entries for more than 20,000 patients find that there is a 41% increased risk of mortality at the start of the year as compared with the end of the year (when residents have gained one year of experience within their respective hospital systems). This transition is also marked by a cohort turnover, where a cohort of experienced doctors leaves the system and is replaced by new and inexperienced care providers. This, in combination with these new providers’ unfamiliarity with organizational systems, spell pitfalls for patient safety.

The ‘Bootcamp’ System

One proposed solution to better prepare new residents for the transition to residency is a ‘bootcamp’ model, an intensive pre-residency program where new residents are taught basic skills needed to properly provide patient care. The tool has been touted as an objective measure for program administrators to ‘better determine the level of individual supervision required.’ (1). Other programs find that intensive simulation-based training during bootcamp may improve patient safety and increase hospital efficiency, while other programs propose a model where new interns ‘shadow’ more experienced practitioners to facilitate the transition to residency. (2) In the UK, 4 days of shadowing is considered mandatory (2).

Assessing the Usefulness of the Bootcamp System

Researchers have evaluated the use of transitional bootcamps for pediatric surgery residents,  in order to stem the tide of increased errors accounting for preventable complications during July. (3) For example, the Canadian Pediatric Adverse Events Study found that more children have adverse events in teaching rather than community hospitals, and that the impact was most visible in children who had surgery. In teaching hospitals, there was a 37.2% rate of adverse events, while at community hospitals, the rate was 21.5%. (3) The bootcamp system was found to be potentially useful in easing the transition from medical school student to resident.

No Substitute for Experience

While bootcamps and simulation training programs are one way to help ease the transition between medical school and residency, there is no substitute for experience. Inexperienced residents are prone to medical error – medical errors that can potentially permanently injure the patients under their care. Even the best transitional programs cannot substitute for years of training and clinical experience.

This means that bootcamp programs cannot on their own eliminate the July effect. Indeed, the July effect will persist, as inexperience is a fact of medical residency. The only way to significantly reduce the rate of medical errors by residents is consistent oversight by trained attending physicians – physicians that can catch the mistakes of the inexperienced.

References

• Clayton A. Alfonso. Intern Boot Camp: Is it Better to Hit the Ground Running?  Obstetrics & Gynecology VOL. 126, NO. 4 (SUPPLEMENT), OCTOBER 2015, page 50S.
• Pritam Singh et al.  Development, Organisation and Implementation of a Surgical Skills ‘Boot Camp’: SIMweek. World J Surg (2015) 39:1649–1660.
• Blackmore Christopher et al. Targeted needs assessment for a transitional “boot camp” curriculum for pediatric surgery residents.  Journal of Pediatric Surgery 50 (2015) 819–824.