Lt. Courtney Detring sat outside a patient exam room at Naval Medical Center Portsmouth March 18, waiting to be called in by the specialist. But Detring wasn't the patient - she's an intern at NMCP and was participating in a new General Medical Officer Curriculum Course in the Healthcare Simulation Center.

Detring and four other interns spent the morning rotating through five standardized patient encounters - a live, simulated patient and a board-certified specialist set the scene, and then the intern entered the simulated exam room as the doctor. During each "appointment," the specialist graded the intern on his or her ability to gather a patient history, perform an assessment and develop an appropriate treatment plan.

The course is for interns who will become sole practitioners assigned to ships, submarines and squadrons - general medical officers, undersea medical officers or flight surgeons - after they graduate from their yearlong internship in June.

"I think it's going really well," Detring said as she waited to be called in for the final scenario. "I'm definitely glad that we have the opportunity to go over cases that we will see, or at least be prepared for something we may see, and need to be able to handle. I'm excited to have that opportunity."

The five patient scenarios are overseen by specialists in general surgery, mental health, neurology, emergency medicine and cardiology, and are Phase 2 of the course. During Phase 1, interns attend skills sessions where specialists work with a small group of interns to make sure they are proficient in basic procedures, called core competencies.

The course was developed after the core competency requirements for general medical officers in the Navy, Air Force and Army were revised. NMCP is the first Navy hospital to develop a program specific to GMO-designated interns using the simulation center. The goal is to export the program to other hospitals with a Graduate Medical Education Program.

"Internship is not as broad as medical school," said Lt. Cmdr. (Dr.) John Alex, an emergency physician and the deputy director of the Healthcare Simulation Center. "There are surgery interns who have been doing surgery this whole last year, so maybe three-quarters of their rotations are in a surgical subspecialty. Maybe they haven't seen a lot of low back pain or dealt with a lot of headaches, whereas a transitional intern or an emergency medicine intern has rotated through the hospital and has probably seen these types of cases. So this is to refresh the skills they may not have practiced recently, as well as ensure they have a certain level of confidence in treating their patients."

The core competencies range from splinting and immobilizing extremities and the removal of skin lesions, to toenail removal and peripheral nerve block anesthesia. The Phase 1 sessions are offered regularly, and the Phase 2 sessions are held each month. Interns must complete both phases by June.

"Many of us recognize that we were often put in austere environments by ourselves as relatively junior physicians and that this kind of training would have been invaluable to us," said Cmdr. (Dr.) Carl Petersen, associate director for Professional Education, which oversees the Graduate Medical Education programs. "We are all excited that we can give this training to our intern graduates before they leave."

During both phases, interns can ask questions of the specialist to ensure familiarity with the common complaints presented during the patient "appointments," and familiarity with the steps performed during the skills sessions. The result is one-on-one feedback from the specialists. The specialists highlight what the interns are doing well, and offer constructive criticism for areas they need to work on.

"I was very, very impressed, very pleased with their performance," said Petersen, a psychiatrist who proctored the Phase 2 mental health scenario. "Certainly some of them needed a little bit of guidance and some feedback, but by and large, I was very impressed with their performance and feel very comfortable with all of them going out to the fleet at this point."

"The training reminds me of a course we took to finish medical school with the standardized patients, which helps us learn which questions to ask," said intern Lt. Paul Maldonado. "Completing the 23 core competencies are skills that we will actually use in the fleet."

"I think this is a great opportunity to have some experience with the 'bread and butter' things that we are supposed to know as a GMO, but that we may not be doing every day here (during the internship)," Detring added. "It's definitely good to either get a refresher if it's something you are familiar with, or if you haven't ever seen it before, you're first time isn't going to be out on your own. At least you've seen it and know the basic steps of what you need to do."

For more news from Naval Medical Center Portsmouth, visit www.navy.mil/local/NMCP/.