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ByLindseyTanner APMedicalWriter CHICAGO First-day jit- ters come with any new job but when the work in- volves pushing needles into strangers' bellies, stitching up gaping wounds or even delivering babies, that de- but can be especially nerve- wracking — for everyone involved. Brand-new doctors of- ten launch right into pa- tient care within weeks of graduating from medical school. To make sure their skills are up to snuff, many medical schools and hospi- tals run crash courses in the basics for these new in- terns. It's called boot camp at Northwestern Memorial Hospital and its adjoining Feinberg medical school, a program involving two to three days of intense practice before letting the newbies loose on patients. Young doctors are tested on a variety of skills, from the proper technique for handling newborns during childbirth — make sure the head comes out slowly — to delivering bad news — use empathy, eye contact and listen to the patient. More than 90 percent pass the first time. The rest are tested again until they do. "Don't do that on Mr. Smith," instructor Dr. Jef- frey Barsuk told this year's batch of residents, warning them not to withdraw too much fluid from the belly of a mannequin patient sup- posedly sick with liver dis- ease. Barsuk was showing the group how to insert a scary-looking 5-inch needle and remove abnormal fluid buildup. Taking too much can be dangerous for sick patients. Dr. Diane Wayne, the medical school's vice dean of education, created the program in 2011, aiming partly to combat the so- called "July effect." Many experts say it's more myth than reality, and evidence is mixed, but a few studies have found lapses in patient care — even deaths — when new interns start making rounds in July. "We have great residents who come from all over the country, but we have no re- liable way of knowing that these interns possess these skills," she said. "We just don't want to subject pa- tients to newly minted res- idents" with uncertain ex- pertise. The program won a 2012 innovation award from the Association of American Medical Colleges. The as- sociation's Dr. Robert Eng- lander said the boot camp is part of a trend in doctor- training as hospitals in- creasingly focus on patient safety. "We're looking more and more at what we can do toward the end of medi- cal school to optimize that preparation," he said. Bennet Butler, 26, just got his doctor degree from Northwestern and was among about 100 grads in this summer's just-finished boot camp. He gave it high marks on his first day. "We're learning a lot al- ready," said Butler, 26, after a refresher course on identi- fying surgical instruments. "We've had a couple of lec- tures, a couple of sessions where we were able to prac- tice some of our skills like tying knots and suturing so, so far so good." Butler said he's excited but anxious about starting his residency. "This is something I've wanted to do my whole life," Butler said. "You'd have to be crazy not to be a bit ner- vous," he added. "It's a big upgrade in re- sponsibility." One of the toughest — and most praised — ses- sions was a test in handling end-of-life discussions, us- ing actors trained to por- tray dying patients. First, the new doctors watched rapt as Northwestern eth- ics expert Dr. Kathy Neely demonstrated with an ac- tor posing as single father with advanced cancer, wor- ried sick about what would happen to his 12-year-old son. It was like a well-acted play, with the audience straining to catch every word and nuance as Neely sat close to the "patient," touching his arm and talk- ing gently about the bur- dens of choices he faced, including entering hospice care. Then residents were sent into private hospital rooms to be tested on discuss- ing "do not resuscitate" or- ders and how long to use life-saving ventilators with other fake patients. "It was difficult going in because we were giving bad news to the patient and dis- cussing end of life goals," said Namita Jain, 25, an- other recent Northwestern graduate. Facing her first day on the job, Jain said she was most nervous about "prob- ably, like everything," but praised boot camp for help- ing build up her confidence. "It's nice to be able to prac- tice." MEDICAL FIELD No practicing on patients: New docs get boot camp InthisJune25photo,FrancesTangherlini,asurgicalintern,practicesknottyingsutures during an intern boot camp exercise taught by Northwestern Memorial Hospital and Northwestern University's Feinberg School of Medicine in Chicago. ASSOCIATED PRESS PHOTOS In this June 25photo, Fardows Salim holds up a fake baby that she delivered during a birthing exercise taught during intern boot camp by Northwestern Memorial Hospital and Northwestern University's Feinberg School of Medicine in Chicago. By Ellen Mccarthy The Washington Post WASHINGTON The swelling ranks of Americans adopt- ing gluten-free diets have given rise to another hot trend: people calling the whole thing a bunch of ba- loney. And then requesting that the baloney be sand- wiched between two pieces of white bread. Served with a cookie for dessert. David Klimas has a friend who recently went gluten-free, a development that the 46-year-old real estate sales manager in Al- exandria, Va., greets with a slow eye roll. He thinks that the gluten-free thing is just a fad, promoted by food companies "as a way of making money." "In the '50s, everyone had ulcers," he says. "Then, it was back problems. Now, it's gluten." Gluten abstinence has grown dramatically over the past several years. Ac- cording to a survey by the NPD Group, a market-re- search firm, nearly a third of adults say that they're trying to either eliminate or cut back on gluten, a combination of proteins found in wheat and other grains. And this movement has spawned a burgeoning food industry valued at at least $4 billion and perhaps more than $10 billion — and climbing. Entire aisles at grocery stores are dedicated to the diet. Restaurant chains in- cluding Bob Evans, Hooters and Uno Pizzeria and Grill, offer gluten-free menus. Trade shows devoted to gluten-free products have popped up nationwide. Bars use menu icons to denote gluten-free beers. All of which makes some people want to bang their heads against a flour mill. "I don't get it," Klimas says of his friend's decision to cut gluten from his diet. "How can you all of a sud- den be gluten-free? He's 45. . . . Sometimes, I think it's just for him to be cool in front of the waiters." About 1 percent of the American population suf- fers from celiac disease, according to the National Foundation for Celiac Awareness. This is a con- founding affliction in which gluten consumption causes damage to the small intes- tine and interferes with the body's ability to absorb vi- tamins. Other people are sensitive to gluten and have negative reactions to consuming it but don't have celiac disease. People who have celiac disease are often misdiag- nosed before the cause of their health issues — which can include digestive prob- lems, rashes, fatigue, head- aches and joint pain — is pinpointed. The only treat- ment for the disease is to give up gluten. There has been a con- certed effort to raise aware- ness of celiac disease, so that those living without a proper diagnosis can see an end to their suffering. But some people believe that the push has caused new gluten-free converts to be- lieve that they have a dis- ease they don't have. The gluten-free back- lash reached an apex last month, when comedian Jimmy Kimmel remarked on his late-night show that in Los Angeles, gluten was "comparable to Satanism," and sent a film crew to ask gluten-free dieters whether they knew what gluten was. (Most didn't.) Talk- show host Chelsea Handler and a disgruntled Charlize Theron deconstructed the issue on-air after Handler sent gluten-free cupcakes to her friends, including Theron, for the winter hol- idays. "I just think that if you're going to send a gift, let it be enjoyable," fumed Theron, who said that the confection tasted "like cardboard." Daniel Leffler, director of research at the Celiac Cen- ter at Beth Israel Deaconess Medical Center in Boston, said that between 2 million and 3 million Americans re- port maintaining a gluten- free diet, and about 10 per- cent of that group has ce- liac disease. 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