“Bootcamp” and the purpose of the 4th year of medical school

Disclosure: I serve as a track director for some of the below described activities for our MS4 students, and was a director for the curricular redesign at Utah from 2008-2011.  I wouldn’t say I’ve had a big financial gain from this, but I definitely have had “skin in the game,” so to speak.

This afternoon we wrapped up Week 3 of our 2nd annual “Transitions to Internship” course for our soon-to-graduate 4th year medical students.  The University of Utah implemented a curricular transformation in 2009; a key part of this change involved the creation of tracks during the 4th year based upon student specialty choice.  We spend part of the academic year providing direct mentoring to our students about the residency application and interview process and in April we have a four-week internship preparedness course.  As part of these changes in the 4th year we have also provided more clear structure for the students regarding recommended and required courses during the 4th year.  While there has been a historical debate about using the 4th year as an opportunity for professional development versus personal development.  Students have unique individual needs based upon specialty selection, background, academic performance to date, long-term interests…in short, a plethora of factors (many of which are not controllable) influence what constitutes an “ideal” fourth year.  A new facet is brought to this dialogue by the recent ACGME mandate for direct intern supervision while on-call as residency program directors have an immediate and salient interest in the content of the fourth year curriculum. Most recently, the proposed core Entrustable Professional Activities (EPAs) have sought to describe a minimum core of skills, attitudes, and behaviors that should be present in interns on Day 1.

Not surprisingly, as someone who works closely with our 3rd and 4th year medical students, I have pretty strong opinions about the 4th year and how it would be used in a perfect world.  Ideally, it serves as a capstone year for career development, with both optimized clinical involvement and non-clinical leadership and learning opportunities.  I tend to agree with the surveyed program directors cited above who counsel against students spending a significant portion of their 4th year doing rotations in their future specialty; the truth is, they have the rest of their lives to do those things.  What I do want them to do is graduate as a well-rounded physician with a broad medical knowledge foundation that will serve them well in that chosen specialty.  My general surgery advisees know that means that I’m going to tell them to spend time in the ED, with anesthesiology, and with medical subspecialties- all things that are relevant to their future practice but that they are unlikely to have dedicated time to study once they start internship.  I tell them to do ONE month of surgery sub-internship, with the intent being to truly prepare them to be an intern in surgery, and one month of ICU service (because it will be valuable their first night on call).  I believe the addition of an intern prep course/ bootcamp to the curriculum is invaluable, and I appreciate knowing that my students are leaving here with a certain baseline set of skills that I can document.  If I could advise them to do a month-long leadership elective- something I am passionate about- they would do that.  My interest in students having a leadership elective option has become even more strong over the last few years as my own career has evolved; that month I spent in Austin working with the Texas Medical Association lobbyists as an MS4 has proven invaluable in my role on the SurgeonsPAC Board since 2011.  Blogger’s note:  See, I wasn’t just goofing off in Austin the month before graduation, though I don’t know of a more beautiful place in May.

And audition electives?  Honestly, I would make them go away if I were queen of the medical student world.  I thoroughly understand the arguments for and against, but at the end of the day…they’re costly, and in my own specialty they seem to not be terribly high-yield.  Those two months I spent doing them as an MS4 simply helped me learn that I didn’t want to be an intern at either institution I spent time (which maybe does have some value after all).