No Intern Left Behind: Using a Dedicated Transition to Discipline Block Improves Resident Outcomes

This article was migrated. The article was marked as recommended. Introduction: A program was developed for incoming PGY-1 residents using the Accreditation Council for Graduate Medical Education milestones ratings. This program detects critical deficiencies and works to correct them as early as possible. Methods: A one month period was used for this transition to discipline block to identify at-risk learners. The block utilized cased-based discussions, interactive lectures, simulations, and clinical core rotations. All activities were tied to milestones measures to recognize deficiencies and provided a goal to correct the individual's progression. Results: Interns that completed the transition to discipline block were compared to the most recent previous class at the same institution. The same number of individuals with critical deficits were found in each class at first milestones rating (4 deficits per class, p value 1.0). The intervention classes had critical deficiencies recognized earlier and all identified deficiencies were extinguished earlier. Medical knowledge as compared by In-Training Examination percentile scores improved (Pre-Intervention Mean Percentile 28.9, Post-Intervention Mean Percentile 49.5, p value 0.005). Discussion: A milestones-based transition to residency block identified critical deficiencies earlier, which allowed for earlier intervention and improvement in resident performance. A similar process may benefit other residency programs.