The beginning of any residency program is an exciting time, where new resident physicians are expected to triage and respond to an incredible amount of pages.
"Studies estimate that first-year residents receive between 22 and 57 pages per shift," says Samantha Leigh Kempner, M.D., a clinical assistant professor who specializes in medical education, as well as general obstetrics and gynecology at Michigan Medicine. "Many studies have shown that interns are not always adequately prepared to respond to this many pages. And these skills are not always taught in medical school."
This led Kempner to team up with Lauren Heidemann, M.D., a clinical assistant professor who specializes in internal medicine, to create an educational platform where future residents could prepare themselves for this aspect of their training.
"We developed the simulated paging curriculum at the University of Michigan Medical School as a key component of the new residency preparation courses – or RPCs – that all fourth-year medical students are required to complete immediately prior to graduating," says Kempner. "We view the program as an inter-professional experience, as it really takes on a collaborative approach to learning."
During the program, each student receives six to eight pages regarding a simulated patient with a condition that requires urgent attention.
"These specialty-specific pages can include patients with a variety of conditions, including post-operative pain, mental status changes and respiratory failure," adds Kempner.
In order to respond to these pages, each student immediately calls a designated phone number to speak with a registered nurse. During this call, the student and RN discuss the patient care situation and make recommendations for next steps.
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"This phone call allows the intern to connect with a nurse regarding patient symptoms and vital signs," says Kempner. "They then decide on further action, like lab tests and/or diagnostic imaging."
Kempner adds that each of these pages is unique, as they unfold with a variety of challenges commonly faced by interns during their residencies. And at the end of every call, the nurse grades the student on a rubric that includes categories like decision making, communication and professionalism.
Aside from this program being unique to the U-M Medical School, it is also notable because:
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Nurses play an integral role in the education (and corresponding assessment) of these fourth-year students;
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The curriculum does an effective job of assessing student abilities to perform initial evaluations and manage urgent medical conditions; and
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Inter-professional communication skills are measured beyond the traditional face-to-face encounters.
"I think it's important to remember that the medical school to residency transition point is really significant for a number of reasons," says Kempner. "This is a really critical time for students to recognize the importance of collaboration when it comes to their future roles. This year, we're also piloting a program where we're looping in students from the U-M School of Social Work, as well as other consultants in different fields."
Kempner adds that the conceptual framework of "deliberate practice," developed by renowned psychologist, K. Anders Ericcson, serves as the basis for the mock paging curriculum.
"Deliberate practice is unique in that it involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance," she says. "The simulated paging curriculum provides a platform for authentic inter-professional collaboration which can be used in many other areas of health professions education."
And according to fourth-year medical student, Devin Shen, M.S., the program has already made a significant impact on his future.
"The RPC mock paging curriculum was instrumental in my preparation for residency. We were responding to patient cases as if we were real residents getting paged on call. We had direct feedback from the nursing staff, which I really appreciated. This gave me the confidence I need to start residency in just a couple of months."
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