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TFI Daily News

World News for World Changers

Jul 16

Chicago’s Intern ‘Boot Camp’ Is a Rehearsal for Life or Death Medical Issues

By Dirk Johnson, NY Times, July 14, 2013

CHICAGO—On the first day of “boot camp,” Dr. Diane B. Wayne asked the Northwestern Memorial Hospital class of new interns for a show of hands if any were nervous.

Some sat still, wearing poker faces.

"Those of you who did not raise your hand," Dr. Wayne told them, "are not being honest."

Everyone’s hand went up.

It is not just the new interns, thrust into settings of real-life health care, who naturally feel some anxiety this time of year. Patients, too, might be a bit skittish. The so-called July Effect, though disputed by some, holds that medical errors spike when beginners arrive at hospitals.

The boot camp, conducted under the watch of Dr. Wayne, the vice chairwoman of medicine at Northwestern University Feinberg School of Medicine, provides the interns with a three-day session in June to prepare them for bedside assignments.

In the view of Dr. Wayne and others, it seems prudent for interns to practice on artificial patients before going to work on those who actually bleed. A study published in the Annals of Internal Medicine in 2011 reported that “mortality increases and efficiency decreases” when a new crew of interns comes aboard.

The 81 interns at Northwestern are graduates of some of the nation’s most prestigious medical schools. But they find themselves in an unfamiliar setting. During the first hour of the boot camp, one intern was reported lost in the building.

Northwestern officials say the program is the most rigorous of its kind in the nation, with a requirement that interns pass graded tests in procedures and communication skills before being allowed to move ahead.

In one life-or-death situation, a robotic patient lay motionless on a bed, tubes sticking into the throat, in an intensive care unit filled with flashing lights and ominous beeping.

Dr. Michael Donnan, 26, who hours earlier donned a badge that read, “M.D.,” was in charge of the crisis.

"This is tricky," he muttered, sounding apprehensive, as he stared at the respiratory screen, weighing his options.

Seeming a bit tentative, he punched in a series of numbers. His colleagues studied his moves, some of them taking notes.

In a few moments, the beeping ceased. The interns waited for a verdict.

Into the room charged Dr. Matthew Nitzberg, the chief medical resident, who had been watching and assessing from behind the glass.

"You killed it!" he said, eliciting a peal of giggles from the interns. What he meant, he explained, was that it was a virtuoso performance. The patient had been saved.

Dr. Donnan exhaled and managed a smile.

As complicated as the medical procedures can be, Dr. Wayne said, students typically have a harder time with communication skills at the bedside. In a boot camp session titled “Difficult Conversations,” residents talk to a dying patient, played by a Chicago actor, Ed Dzialo.

Dr. Suneel Kamath, a graduate of Columbia University College of Physicians and Surgeons, stepped to the bedside of Mr. Dzialo, who said he was “looking forward to the summer” and “going back to work.”

The intern needed to explain that a bowel obstruction had made it impossible to do any further chemotherapy or surgery for the man’s colon cancer. The patient likely had only weeks to live.

"I hate to be the bearer of bad news," the intern said. Mr. Dzialo, his eyes fixed with fear, listened to the grim prognosis, then turned his head to the side.

"I’m dying," said the actor, lamenting that he was in his 40s and had "wasted my life."

Dr. Kamath tried to reassure the patient otherwise, telling him that he had “worked hard every day” and done his best.

As the patient looked away in dejection, the intern said he wanted to raise end-of-life issues, like who would be designated to make a decision to remove him from life support. The intern conceded that these were “not fun topics.”

After the session, the actor asked Dr. Kamath to assess his bedside manner. The intern gave himself good marks, saying he believed he had appropriately “stayed on task.”

Mr. Dzialo, who has been trained by palliative experts about such discussions, was a bit more critical. He noted the “not fun” phrase, rather an understatement in the context. He also suggested that the young doctor focus on “exploring my feelings,” instead of “telling me” how he had lived his life.

Dr. Kamath acknowledged that having a discussion with a dying patient, albeit an actor playing a role, was quite different from learning from a textbook.

As the boot camp officials see it, this was a lesson that will prove useful in the future, when a scared, dying patient is not pretending.