The IM Bootcamp:
preparing interns for July
The step from the last day of medical school to the first day of internship is the sharpest increase in responsibility in a physician’s career, and it happens overnight. For fifteen years, program directors and residents have been asked what new interns most need, and they keep giving the same answer — which is not the answer most curricula are built around. This page sets out what the evidence says, how a bootcamp should be designed because of it, and the small-group curriculum built from it. It is a free, program-agnostic curriculum that any US internal medicine residency can adopt.
Why a bootcamp
Every July, thousands of new interns take responsibility for patients for the first time. They are, on paper, prepared: they have passed their examinations and completed their clerkships. What changes is not what they know but what they are accountable for, and no single examination measures the difference.
Medical schools have responded with capstone and “transition to residency” courses. Residency programs have responded with orientation. The two rarely talk to each other, and what happens in the weeks after orientation ends is largely unspecified.
In 2023 the Alliance for Academic Internal Medicine published a national consensus on what should be taught on each side of that handoff — one table for the medical-school capstone, another for residency orientation. A footnote to the orientation table gives explicit permission for what this project is:
“Low-priority topics can be incorporated into intern survival series/boot camps during the first 1–2 months of residency.”
The consensus names the instrument and then stops. Nobody has built it as something a program can pick up and use. That is the gap this bootcamp is meant to fill: a receiving curriculum, evidence-anchored, free, and belonging to no particular institution.
What interns actually need
Three different groups were asked, by three different methods, more than a decade apart. They agreed.
Program directors. In a national survey of internal medicine residency program directors — 282 of 377 responding, a 74.8% response rate — the highest-ranked skill expected of a brand-new intern was knowing when to seek assistance. It was rated a high priority by 270 of the 282 respondents, or 95.7%, and it sat significantly above everything else on the list.
Residents. Three years later, 20,484 internal medicine residents — 83% of everyone who sat that year’s In-Training Examination — were asked the same kind of question. Their top two answers were identifying when to seek additional help and expertise (89.1%) and prioritizing clinical tasks and managing time efficiently (88.0%). The people who had recently been interns and the people who supervise them named the same skill first.
The national consensus. The 2023 AAIM recommendations reproduce these findings as high-priority topics for residency orientation: handoffs, cross-coverage, organization and time management, and knowing when to escalate.
What is missing from the top of every one of these lists is as instructive as what is on it. When the 282 program directors wrote in their own words — 559 free-text responses — organization, prioritization, and time management dominated. Core medical knowledge drew 16 mentions. Procedural experience drew one.
This is not an argument that knowledge and procedures do not matter. It is an observation about what a new intern is missing in July, and therefore about what the first weeks of residency are for. The knowledge is mostly there. The system for deploying it under time pressure, with real consequences, and the judgment to know when to stop and call someone — those are not there yet, and they are not what most orientations spend their hours on.
Where the floor actually sags
Asked to name the topics they felt least prepared for, incoming interns pointed to a consistent short list. In the first published analysis of AAIM learning plans, oncologic emergencies led by a wide margin (67.6%), followed by transfusion management (34.2%), acid-base disorders (28.8%), and anticoagulation management (25.2%). Their most common stated goal was simply efficiency (61.3%), and the area they most wanted to improve was ICU-level care (59.5%).
Treat that list as a hypothesis rather than a national finding. It rests on 111 learning plans — a 14% sample of those completed — from three institutions that volunteered them, and the authors say plainly that the sample size “could have introduced bias.” It is still the best available evidence on where interns think their own floor is weakest, and it is a better guide to which refreshers to build than an educator’s intuition. It is also a rebuke to the usual lineup: sepsis and electrolytes get taught every July; oncologic emergencies and transfusion medicine rarely do.
How it should be taught
Asked which fourth-year experiences best prepared them for internship, residents chose the ones that carried responsibility: the sub-internship (63.3%) and ward rotations (59.8%). Ranked near the bottom, at 2.8%, was the capstone or “internship 101” course.
It is tempting to read that as a verdict against classroom teaching, and the temptation should be resisted. The authors of that study were careful, and so should we be: capstone courses “are not offered at all medical schools, and they do differ across those schools that offer them, which could account for their low rating.” They called for more research into the ideal content of such courses before anyone mandates them. A low ranking may measure availability rather than value.
What the finding does support is the positive claim, and it is strong: interns learn this material by carrying responsibility, not by hearing about it. The design consequence is not to abolish teaching but to simulate the responsibility — evolving cases where a decision changes what happens next, cross-cover calls at the wrong hour, a consent conversation with someone who says no.
AAIM says the same thing in its own words, recommending that transition curricula use “effective methods of pedagogy such as simulation, small group discussion, and role-playing rather than traditional didactics,” and that programs use chief residents and senior residents for “near peer” teaching. The people who were interns last year are the best teachers of what it is to be one.
The assessment spine
Step scores never measured workplace readiness well — and since Step 1 became pass/fail, programs have even less standardized signal of any kind, while the pandemic left real, uneven gaps in clinical exposure. The AAMC’s thirteen Core Entrustable Professional Activities describe what a graduating student should be able to do on day one; they define the floor a bootcamp reviews rather than reteaches. The honest response is not to assume that floor but to sample it early in the first week — after the local safety essentials are taught, never instead of them.
The spine has four movements:
- An intake self-assessment. AAIM’s Individualized Learning Plan asks incoming interns to name where they feel least prepared. It was piloted across 52 residency programs, and the first analysis of what interns actually write was published in 2025.
- A diagnostic OSCE, day zero to one. Standardized-patient stations aimed squarely at the consensus non-negotiables — a handoff, a cross-cover call, sick versus not-sick triage, informed consent, code status, order-writing logic. This is assessment, not teaching.
- A behaviorally scored experiential circuit, week one. Evolving cases that braid clinical reasoning with communication, systems, and professionalism, each mapped to the Milestone domains it exercises and scored on observable behaviors — the Milestones themselves are the committee’s longitudinal synthesis, never a single station’s scorecard. Formative, never a ranking.
- An updated learning plan, handed to the intern’s advisor. The bootcamp’s output is not a score. It is a plan a human being will act on.
The tail — procedural familiarization, electronic-record efficiency, death pronouncement, topic refreshers — drips across weeks two through eight as the “survival series” the consensus describes.
Five pillars
Modules are organized around the five core intern-readiness skills named in the AAIM and CDIM subinternship curriculum: time management, team communication, recognizing the sick patient, knowing when to ask for help, and wellness.
| Pillar | Modules |
|---|---|
| A. Clinical readiness | Recognizing the sick patient and first response · cross-cover and night triage · the first rapid response and ICU first night · high-yield data interpretation (ECG, chest film, blood gas, electrolytes) · targeted topic refreshers |
| B. Ward & clinic operations | Your personal system: day structure, task tracking, prioritization · roles, supervision, and graduated autonomy · escalation and when to call your senior · handoffs and transitions · orders, prescriptions, and documentation logic · a day on the wards and in the ICU · the ambulatory bootcamp |
| C. Communication & professionalism | Difficult conversations: consent, capacity, bad news, code status and goals of care, suicide-risk assessment, working with an interpreter · professionalism dilemmas · keys to a successful residency |
| D. Career & life | Resident financial planning · fellowship and career toolkit · getting started in scholarly work |
| E. Wellness | Intern wellness, fatigue and fitness for duty, recognizing burnout in yourself and others |
Two of these deserve their own note. Time management gets a dedicated module because it is the most-cited need in every survey and is usually taught nowhere. Escalation gets one because “knowing when to seek assistance” ranks first with both program directors and residents, and is almost always left to be absorbed rather than taught.
What it leaves out
A curriculum is defined as much by its exclusions. The AAIM task force considered and explicitly did not recommend three things for transition curricula: leadership skills, the fundamentals of patient safety and quality improvement, and health systems science. They are important. They are not what a new intern needs in July, and a bootcamp that tries to teach everything teaches nothing.
Procedural proficiency is likewise out of scope — one mention among 559 free-text responses from program directors. Familiarization, yes, later, in the tail. Proficiency belongs to the years that follow.
Systems, safety, and equity are not absent; they are braided into the cases rather than bolted on as lectures. A discharge summary written under pressure from a case manager teaches systems. A patient who needs an interpreter and does not get one teaches equity.
National skeleton, local organs
The reason a portable bootcamp does not already exist is that so much of orientation is irreducibly local. The answer is not to pretend otherwise but to draw the line in the right place: ship every module complete, with clearly marked slots where local content plugs in.
Seven categories are local by nature — the electronic record and its click-paths, the antibiogram, state law, the schedule and coverage architecture, program policies, people and contacts, and billing and payer specifics. Everything around them generalizes. How to read an antibiogram is national; the antibiogram is local. The logic of an admission order set is national; where the button lives is local. Teaching the local layer as if it were the curriculum is the most common way orientation wastes its own best hours.
State law deserves particular care. Involuntary holds, expedited partner therapy, minor consent, testing consent, prescription monitoring, and death certification differ by jurisdiction, and material written in one state must never travel as though it were nationally general.
For international medical graduates
The 2023 consensus lists acculturation of international medical graduates as a high-priority orientation topic, qualified with the words “if applicable.” In internal medicine that qualifier does very little work. IMGs are a substantial share of incoming internal-medicine classes nationally, and in many programs the majority.
What that module has to cover is rarely written down anywhere: how American ward teams actually make decisions, when it is expected that you call an attending at night and when it is not, what a consult request is supposed to sound like, how disagreement is voiced, how documentation norms differ, and the sheer volume of idiom in a language you may already speak fluently. None of this is medicine. All of it determines whether a superb physician looks like one in July.
It is worth being honest about how thin the evidence underneath that module is. The learning-plan analysis above — the closest thing we have to interns telling us what they need — drew 83% of its sample from US allopathic graduates and only 9% from international medical graduates. Nobody has asked this question of IMG interns at scale. Until someone does, a bootcamp that claims to serve them should say so, and should listen harder than it lectures.
This work is, in a sense, the whole reason the foundation exists. If you are an IMG heading into internship, the IMG hub covers the road that ends where this bootcamp begins, and Dr. Bray mentors IM-bound IMGs at no cost.
Where this stands
This page is the strategy; the curriculum is built. The bootcamp is a prerequisites block plus a three-day intensive for incoming interns — case-based small-group sessions run in late June or early July — plus a weeks-2–8 extended curriculum: the systems add-ons (coding and insurance, the hospital machine, EMR efficiency, the rotation map, procedures and POCUS), IMG acculturation, the localization shells (antibiogram, state law), the skills and refresher frameworks, the assessment spine made concrete (a formative intake OSCE blueprinted across the Milestone domains, the CCC-and-ILP explainer, the program-logistics worksheet), and the PGY-2/PGY-3 transition series. The full set is published on the hub. A monthly reminder series carries the material through the rest of intern year — one retrieval-first half hour a month, timed to when each topic becomes real again. The program-side machinery — scheduling, staffing, facilitator selection, and evaluation — is deliberately left to the adopting program: each session carries its own running-the-room plan, and the localization slots mark what is local by design.
Dr. Bray directed an internal medicine residency program from 2017 to 2024 and ran an intern bootcamp there across five cycles; this curriculum draws on that experience. What appears here is governed by standing rules:
- Nothing derived from real patient records appears here. Every case is a fictional composite.
- Third-party material stays with its owners. National curricula and milestones are linked to their publishers, not rehosted.
- Nothing identifies residents, alumni, or faculty.
- Clinical content is kept current, and every module carries the date it was last reviewed.
This site advocates for no program, employer, or health system, and this bootcamp names none.
If you direct or coordinate an internal medicine program and would like to pilot a session, or if you are an intern who wishes something specific existed, say so. That is how this gets built in the right order. The full three-day schedule — and which sessions are live — is on the bootcamp hub.
Sources
- Angus S, et al. “What skills should new internal medicine interns have in July? A national survey of internal medicine residency program directors.” — Academic Medicine, 2014;89:432–435 (282 of 377 program directors; help-seeking ranked first, 95.7%)
- Pereira AG, et al. “Important Skills for Internship and the Fourth-Year Medical School Courses to Acquire Them: A National Survey of Internal Medicine Residents.” — Academic Medicine, 2016;91:821–826 (20,484 residents; help-seeking 89.1%, time management 88.0%; sub-internship 63.3%, capstone 2.8%)
- DiMarino LM, et al. “AAIM Recommendations for Undergraduate Medical Education to Graduate Medical Education Transition Curricula in Internal Medicine.” — The American Journal of Medicine, 2023;136:489–495 (the national consensus; the “intern survival series/boot camps” language and the excluded topics are quoted from this paper)
- Pincavage AT, et al. “Evaluation of an Individualized Learning Plan Template for the Transition to Residency.” — Journal of Graduate Medical Education, 2023;15:597–601 (the ILP pilot, 52 programs)
- Falk E, et al. “Initial Analysis of Internal Medicine Intern UME to GME Individualized Learning Plan Content.” — Journal of General Internal Medicine, 2025;40:2153–2156 (111 learning plans, a 14% sample, from three volunteering institutions; 83% US MD, 9% IMG, 7% US DO. Oncologic emergencies 67.6%, efficiency 61.3%, ICU-level care 59.5%. The authors note the sample size could have introduced bias.)
- AAIM — UME to GME Transition (Individualized Learning Plan template and learner handoff standards)
- ACGME — Internal Medicine Milestones (assessment vocabulary)
- AAMC — Core Entrustable Professional Activities for Entering Residency (the thirteen EPAs defining the expected floor)
- Alliance for Academic Internal Medicine and Clerkship Directors in Internal Medicine — Internal Medicine Subinternship Curriculum 2.0, 2018 (the five core intern-readiness skills), and the Core Medicine Clerkship Curriculum Guide v4.0, 2020
Every statistic on this page was checked against the primary paper rather than a summary of it. Where a study’s authors qualified their own finding — as Pereira and colleagues did about capstone courses — the qualification is printed alongside the number. This page is educational and is not a substitute for your program’s policies, your institution’s training requirements, or the law of your state. Last reviewed July 2026.