The monthly reminders:
booster cases through intern year
The bootcamp ends and the forgetting begins the same week. The fix is not a longer bootcamp — it is the two techniques with the strongest evidence in the learning literature, spacing and retrieval practice,1 applied to the curriculum itself: one half hour a month for the rest of intern year, opened by questions rather than review,2 built around one fresh case, and timed to the month that makes the material real again — the winter census, the mid-year review, the February wall.
The design rules
- Retrieval, never re-lecture. The half hour opens with five questions from the parent session, asked cold and answered out loud before any review. Testing is not measurement here — it is the intervention: retrieving a memory strengthens it more than restudying does.2 A reminder that opens with a recap slide has already failed.
- Timed to the moment. Each booster lands the month its material becomes real again — code status before the winter census, money at tax time, teaching before the room flips. Spacing practice across the year beats massing it,1 and timing it to real patients beats spacing alone.
- One new case, same decision. The booster case is a fresh vignette aimed at the parent session’s central decision point, run the bootcamp’s standard way: disclosed in parts, commitments out loud before consequences are revealed.
- The room’s own stories. By August every question has a face on it. Each reminder makes room for one real version from the last month, under the same ground rules the welcome session set: what is shared in the room stays there.
- Inside time that already exists. One morning-report or noon-conference slot a month, run by the chiefs. No new faculty lift, no new hour to find — the series survives because it costs almost nothing to keep.
The standard half hour
- Five retrieval questions — 10 minutes. Cold, out loud, committed before the answers. Pull them straight from the parent session’s pocket card — every session’s pocket card was built to be its retrieval bank.
- The booster case — 10 minutes. A new vignette, the same decision point, commit-before-reveal.
- The month’s story — 5 minutes. Someone in the room lived this since the bootcamp. Let them tell it; debrief it the way every session debriefs.
- One commitment — 5 minutes. Each intern names the single behavior they will use before the next reminder, and the session closes by naming where to re-read.
The calendar
Eleven boosters, August through June. The months are anchors, not rules — shift any row to fit your block schedule; the half-hour recipe is the invariant.
| Month | Booster | The moment it meets | Draws on |
|---|---|---|---|
| August | The 2 a.m. page, one month in | The first month of real cross-cover is behind the room — every bootcamp answer now has a face on it. | cross-cover · consults |
| September | Handoffs, audited | Sign-out compresses exactly as comfort rises; the contingency lines are the first thing to decay. | handoffs |
| October | The antibiogram, before respiratory season | Empiric antibiotic decisions are about to multiply; the stewardship habits are three months old. | antibiogram & stewardship |
| November | Code status before the winter | Winter census brings the sickest patients — and holiday gatherings bring families ready to talk. | code status & goals of care · serious news |
| December | The mid-winter check | The shortest days, the holidays far from family, the novelty long gone. A check-in, not a lecture. | the sustainable intern · sleep · the struggling colleague |
| January | The mid-year mirror | Semi-annual reviews land near here in most programs; the learning plan is due for an honest revision. | assessment machinery |
| February | The February wall | The year’s longest unbroken stretch, named out loud — because fatigue bends the error curve. | medication safety · error & disclosure |
| March | The clinic, now that it’s yours | Continuity panels have matured into real ownership — and the insurance maze is personal now. | the outpatient transition · the business of the visit |
| April | Money, at tax time | The first resident tax return — and the loan and insurance decisions deferred in July are now real. | money 101 |
| May | Teaching, before the room flips | The Match named the incoming interns months ago; in weeks, this class supervises and teaches them. | conference craft · the PGY-2 transition |
| June | Closing the year | Everyone rotates up at once — the year’s biggest handoff. Pending results need owners; and each intern writes the one line they would put in front of the next class. | handoffs · safe discharge · welcome |
The event-triggered boosters
Three reminders do not live on the calendar — they fire on events, per intern, because the moment they meet cannot be scheduled:
The first ICU block. The week before each intern’s first unit month, a senior who has been there runs the ICU session’s pocket retrieval with them — know-your-patients-cold, the systems presentation, when the nurse’s worry is your worry — plus the first five minutes.
The first death. Within days, a short debrief in two halves: the mechanics get checked — the pronouncement, the family call, the paperwork of the death sequence — and the feelings get named, because the second-victim frame from the error session applies even when nothing went wrong.
The first error. Within the week: the disclosure path retrieved and then walked alongside the program’s actual process, with the supports the error session promised offered in person, not just mentioned.
The chiefs own the triggers. A block schedule tells you when each intern’s first ICU month is coming; the other two you will know when they happen — the discipline is acting within the week, while the event is still a teachable moment and not yet a private weight. And the boosters are for the intern who lived the event, never material for the room: nothing from a real death or error enters group teaching without the involved intern’s consent and full de-identification — the group version waits until it is a composite.
Pocket card
- Retrieval, never re-lecture — the questions come first, cold.
- One new case, same decision point.
- Timed to the month that makes it real.
- Thirty minutes, inside a slot that already exists, run by the chiefs.
- Three boosters fire on events, not dates: first ICU block, first death, first error.
- Close every half hour with one commitment and one place to re-read.
Notes
For the chiefs and program leadership who will run this: the series is deliberately cheap. The five questions come from the parent session’s pocket card; the booster case is one paragraph aimed at a decision the room has already practiced; the slot already exists on your conference calendar. The calendar above assumes a July start — move any row to fit your block schedule and your climate, and if your program collects mid-year self-assessments, let them re-aim the spring rows the same way the topic refreshers are aimed.
This page is a curriculum framework, not clinical instruction; parent sessions carry their own sources and review dates. Last reviewed July 2026.
Sources
- Dunlosky, J., Rawson, K. A., Marsh, E. J., Nathan, M. J., & Willingham, D. T. (2013). Improving students’ learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychological Science in the Public Interest, 14(1), 4–58. https://pubmed.ncbi.nlm.nih.gov/26173288/ ↩1 ↩2
- Roediger, H. L., III, & Karpicke, J. D. (2006). Test-enhanced learning: Taking memory tests improves long-term retention. Psychological Science, 17(3), 249–255. https://pubmed.ncbi.nlm.nih.gov/16507066/ ↩1 ↩2