There’s an old joke in medical circles about never getting sick or needing a hospital stay in July.
Typically, medical students graduate in the summer and most residents are starting their medical training in July in hospitals throughout the country. Some studies say medical errors spike during that month, while others suggest that the worries are overblown.
Either way, Matt Stull, MD, chief resident in the Department of Emergency Medicine, knows that making the transition from medical student to physician is no small task. That’s why Stull and Sarah Ronan-Bentle, MD, associate professor of emergency medicine, developed a month-long course titled "Getting Ready for Residency” to assist fourth-year medical students prepare to enter their residency programs.
Medical students have a new role and responsibilities and are often in new cities.
"We hope to give them a taste of what intern year can be like and help them begin preparing for the massive volume of learning that they will do,” explains Ronan-Bentle. "If students are prepared better for drinking from the firehose, they will have less stress and better coping mechanisms so that they hopefully learn better and enjoy it more.”
The class is learner-centered and various teaching methods are used, says Ronan-Bentle.
"If a topic comes up the students would like to discuss more we build it into the course,” she says. "For example, this year the students had questions about code status, which was not previously covered in the course.”
Code status refers to the level of medical interventions a patient wishes to have started if their heart or breathing stops and influences patient care.
Fourth-year medical students bring complex cases they saw on their wards to share with their fellow students and faculty members to help engage students in building differential diagnosis, says Stull. Faculty teach students to use an approach dubbed "VITAMIN C” to consider symptoms and other medical information when to recognize patterns.
The approach allows students to consider categories of symptoms such as vascular problems, infections, trauma, autoimmune illnesses, metabolic disorders, iatrogenic-related matters, neoplasm and congenital defects to make a diagnosis through the process of elimination, explains Stull.
"Our course focuses on the practical aspects of medicine, as all too often the transition from medical school to residency can be quite difficult due to an abundance of knowledge but an inability to apply it,” explains Stull. "Medical students graduate with a ton of knowledge and they know the medical diagnosis, but they haven’t seen it clinically.”
Medical students get a chance to put some of their lessons into practice by working with simulated patients in a role play scenario called "Nightmares on Call.” The students get a chance to evaluate their peers and offer suggestions on how to deal with some common and stressful scenarios they may encounter when residents, says Stull.
Students are also given an opportunity to practice having difficult conversations with families and patients about new diagnoses and end of life care, says Ronan-Bentle. Experts from various disciplines in the class’ "Top Five Pearls” lecture share tips and techniques they have learned to manage specific patient populations, such as pregnant, psychiatric and surgical patients.
Anshul Srivastava, a fourth-year medical student, who will complete his residency at Boston University in internal medicine, had his response skills tested during a simulation session that involved a patient who suffered an opioid overdose. The person acting as the patient appeared lethargic and suffering from hypoglycemia and hypoxia.
Srivastava learned during the examination that the patient was actually a medical student who was assigned rotations in a hospital. He was faced with the dilemma of what do with that information since as a medical profession he is required to report the overdose of a colleague.
"The way I tried to approach it was, I presented the med student with all the facts. Here is what happened. You died and we brought you back. We found you with a vile of morphine. We gave you narcan and you appropriately responded."
Srivastava wanted the medical student to come clean about his opiate use and to ask his superiors for help. But this wasn’t happening.
"He was refusing to cooperate and didn’t want to come out and say anything more had happened,” explained Srivastava.
"My approach is to let him know that we are all under a lot of stress in the medical profession and I want to be there to help you, but at the same time this needs to be reported because it is very serious,” said Srivastava. "He wanted to let it slide, but this is one of those times where there are no gray areas.”
Stull says the abuse of alcohol and prescription medications is a problem in the medical profession that residents may have to confront at some point.
"This has probably been the most useful class I’ve taken during my fourth year of medical school,” says Srivastava. "Just going over common scenarios we will encounter in three months when I am an intern and thrust in a new environment is really helpful.”
Going over code situations and common causes for chest pains and shortness of breath are among some of those scenarios, explains Srivastava.
"I will be doing this with real patients and not a simulation man in a couple of months, and it’s nice to get all these mistakes out the way here in a safe environment when I won’t hurt anyone as opposed to when I am on the floor and I am looking at a real patient,” he says.
Ronan-Bentle says patients checking into any hospital in July really have little to fear.
"The medical care that anyone gets in July is probably better than it is any other time of year,” she explains. "Everyone, including the attending physicians, is hyper vigilant about residents being in new roles and there is much more oversight.”