Columbia University Medical Center

“Ready 4 Residency” Prepares Students for Patient Care

Students in simulation session

Students collaborate to rescue manikins in urgent medical scenarios during Ready 4 Residency’s simulation classes (photo: Jörg Meyer).

As recent medical school graduates begin their residencies this summer, thousands of newly minted doctors will experience the nontrivial gap between learning about medicine and practicing it.

By the fourth year of medical school, “students have a lot of book knowledge, and they’ve been on the wards, but they haven’t been the ones responsible for patient care,” says Rachel Gordon, MD, associate professor of medicine and epidemiology.

Come July, new physicians must be capable of translating that book knowledge into action.

“There’s a real difference between checking on the exam, ‘Yes, they need oxygen,’ and actually putting the oxygen on. How much oxygen do you put on? Or, you’re giving fluids. They probably all know on the test to give fluids, but do they know which fluids to give and how fast to give them? We have to help them make that jump now,” says Dr. Gordon.

Rachel Gordon

Rachel Gordon, course director of Ready 4 Residency (photo: Jörg Meyer).

Enter Ready 4 Residency (R4R), a course developed and directed by Dr. Gordon that is designed to help fourth-year students bridge the jump from being a medical scholar to a physician.

Virtual rounds are a key element in the monthlong course.

Using an online platform and working in teams, students attend to one primary “patient” per week. When they open a module, a case unfolds—set to appropriate music—and teams must order tests, interpret results, provide a diagnosis, and decide on treatment. (For added realism, doctors’ notes, many taken from actual de-identified medical records, are contradictory in places or peppered with abbreviations.) Real feedback is then provided by residents and attending physicians who volunteer their time to the course.

These online scenarios give students practice without the time constraints of an actual patient care situation. “When you’re in the wards, you want to learn as much about your patients as possible, but there are many things competing for time and energy,” says Dr. Gordon. “This virtual component lets students really individualize and pace their own learning.”

The interactive cases, and the course as a whole, often involve infectious diseases and other commonly encountered medical problems. “I want the students to come out of every session and say, ‘I’m so glad I took that class because that gave me something I need to know on day 1,’” Dr. Gordon says. “I want every session to help them.”

In addition to virtual rounds, R4R offers discussion sessions that address how to manage a variety of situations, including what to do when patients resist treatment, how to disclose errors, and how to write a condolence letter after the death of a patient. Discussions are led by experts in a variety of disciplines, including surgery, pediatrics, and obstetrics & gynecology, and focus on issues that are pertinent across specialties.

Ready 4 Residency Directors 
Foundations of Clinical MedicineMichael Devlin, MD
OB/GYNRini Ratan, MD
PediatricsMarina Catallozzi, MD
Simulations and SkillsJulia Iyasere, MD
SurgeryRoman Nowygrod, MD, and Anne Onishi, MD

Lessons are brought to life, so to speak, with simulation. Under the direction of Julia Iyasere, MD,—and making use of the new simulation facilities in the Roy and Diana Vagelos Education Center (VEC)—urgent medical scenarios are set up using manikins. The students aren’t told what to expect and they must work cohesively in their teams to take care of the patients.

“Initially, during the simulation sessions, the students focus on the medical aspects of the scenario: What medications do I give? How do I fix this? But after a few sessions, they realize that how they work together as a team is just as, if not more, important. Seeing the shift from ‘How do I?’ to ‘How do we?’ is phenomenal,” says Dr. Iyasere. “Through simulation, students understand first-hand how vital team work is in patient care and learn skills they can take with them through their careers.”

Julia Iyasere debriefs students after a simulation session

Julia Iyasere debriefs students after a simulation session (photo: Jörg Meyer).

Dr. Iyasere and other assisting clinicians also host weekly skills classes in the VEC’s anatomy lab. These offer students the chance to practice essential techniques such as intravenous line placement, blood draws, intubation and ventilation skills, and ultrasound.

R4R is still a young, quickly evolving course; it launched in September 2015 after Dr. Gordon’s idea for a blended learning curriculum was funded by the Office of the Provost. Concurrently, educators were interested in revamping a fourth-year course called Back to the Classroom.

“If you’re about to graduate medical school, that’s not the time to go back to the classroom and sit and get lectured all day. You want to put your knowledge into action,” says Dr. Gordon. R4R facilitates this transition through a blended learning model and emphasis on active learning. R4R also dovetails with a broader P&S pilot program to better prepare medical students for residency.

David Chong with students in skills class

David Chong, MD, provides guidance to students during an R4R skills class (photo: Odelia Ghodsizadeh).

The successful implementation of R4R has relied on a host of contributors to teach, provide content, and offer students feedback. “I am so grateful for the numerous residents and attendings across specialties who generously participated in the course,” she says. “I am indebted to many people.”

Dr. Gordon says she and her colleagues are now studying R4R to see how and where measurable improvement occurs. Anecdotally, she and Dr. Iyasere have seen “amazing improvement” in students’ ability to take care of a medical emergency in simulation.

In the future and, hopefully, with a larger budget, Dr. Gordon intends to add material on more specialty-specific and advanced skills. She anticipates that some aspects taught in R4R may also be integrated earlier in the medical school curriculum, especially ones useful for major clinical year.

If the positive feedback from students is an indication, R4R is a major success. Graduates have written the instructors to thank them and recount situations when they felt better prepared because of R4R, and a few have even volunteered to be online educators.

The students have a great time, too, between the gamified course structure (complete with leaderboard) and the instructors’ humorous touches. “It’s totally fun,” says Dr. Gordon. One week into the April 2017 section, “some of the March students emailed me and said they miss it already.”