Development, Organisation and Implementation of a Surgical Skills 'Boot Camp': SIMweek

The Boot Camp Model in Urology: Preparing PGY1 Urology Interns for Practice

PURPOSE OF REVIEW

The purpose of this review is to highlight literature regarding resident boot camps published across surgical specialties with a focus on urology. Herein, we discuss different boot camp iterations, their results, and the integration of simulation into their curriculum. We review program elements such as curriculum, course length, and efficacy as well as areas for continued investigation.

RECENT FINDINGS

The field of urology has grown in both the breadth of knowledge and the complexity of procedures. With urology now being an integrated surgical subspecialty, interns often start on the urology service despite limited experience navigating this unique specialty. The boot camp model is one method by which interns and junior residents participate in consolidated training programs to best prepare them for a patient-facing role and the day-to-day demands of residency. Urology programs, both in the USA and abroad, have begun integrating boot camps into their training programs with positive results. Urology boot camps can be a valuable part of training programs for interns to quickly establish medical knowledge, skills, and efficiency. Boot camps should be easily accessible, have sufficient support from institutions, and provide effective training through various methods such as didactics and simulation.

Implementation of a Standardized Sub-Intern Curriculum Improves Confidence for those Entering a Surgical Residency

OBJECTIVE

Medical students often feel underprepared entering surgical residency. We have previously reported the results of a sub-intern needs assessment (SINA) which informed the creation of a standardized sub-internship curriculum. We aimed to determine if implementation of this curriculum into students' scheduled rotations would improve student confidence in their abilities related to the AAMC Core Entrustable Professional Activities for Entering Residency (CEPAERs).

DESIGN

We surveyed 4th year medical students during their surgery sub-internship. Sub-interns participated in a weekly series of 2-hour didactic sessions. We utilized interactive lectures and case scenarios addressing the pertinent topics identified in our previous needs assessment. The surveys were administered before and after the rotation and linked using unique identifiers. The surveys assessed confidence in each of the CEPAERs as well as the top 25 topics prioritized by our needs assessment. Self-reported confidence in each of the topics was measured using Likert scales (CEPAER scale 1-5, SINA scale 1-6). Pre- and post-curriculum confidence on a variety of topics were compared using paired t-tests.

SETTING

Geisel School of Medicine at Dartmouth/Dartmouth-Hitchcock Medical Center, a tertiary-care academic medical center.

PARTICIPANTS

Fourth year medical students participating in their general surgery sub-internship.

RESULTS

Twelve medical students participated in general and thoracic surgery sub-internships over the course of the study period. Ten (83%) participated in the didactic curriculum and they all completed both the pre- and postsurvey. 100% of the respondents agreed that the curriculum provided a useful supplement to their clinical experience. With respect to the CEPAERs, students reported improved confidence in 77% of the areas, with statistically significant increases occurring in the following areas: ability to prioritize a differential diagnosis (average Likert rating improved from 3.7 to 4.1, p = 0.04), comfort entering and discussing orders (2.9-3.8, p = 0.007), and overall preparedness to be a surgical intern (3.2-3.8, p = 0.02). Students also reported improvement in confidence in 92% of the basic intern responsibility topics, with statistically significant increases in maintenance fluid calculations (Likert rating 3.5-4.5, p = 0.001), repleting electrolytes (3.8-4.6, p = 0.01), interpretation of chest and abdominal x-rays (4-5, p = 0.02; 3.6-4.5, p=0.004, respectively), management of oliguria (3.2-3.8, p = 0.02), and time management/organization skills (4.5-5.4, p = 0.04).

CONCLUSIONS

Implementation of a standardized sub-intern curriculum improved student confidence in 33 of the 38 basic intern responsibilities, core Entrustable Professional Activities, and overall preparedness to be a surgical intern. While limited by a single institution design, we believe these results offer a new avenue for educating and preparing medical students for residency within their existing sub-internships.

Orthopaedic Surgery Boot Camp: An Immersion Course for Medical Students

Introduction

There is a substantial need for orthopaedic surgery-specific boot camps due to the limited orthopaedic and musculoskeletal education in medical school, which inadequately prepares medical students for their orthopaedic surgery sub-internships. The aim of this study is to identify the impact of the novel orthopaedic surgery boot camp on medical students’ confidence with key orthopaedic topics.

Methods

A cross-sectional study was conducted using an anonymous online survey distributed to medical students attending the novel orthopaedic surgery boot camp. The boot camp consisted of a four-day immersion course into the basics of orthopaedic surgery principles through both didactic and skills-based educational series. The medical students’ confidence in orthopaedic surgery clinical and technical skills were assessed by comparing the students’ survey responses before and after attending each of the sessions.

Results

Twelve fourth-year medical students and 15 second-year medical students attended the boot camp. All the sessions attended by the medical students were statistically significant in improving their confidence in the subject matter and skills-based training. Hundred percent (100%) of the fourth-year medical students recommend future orthopaedic surgery-bound medical students to attend this boot camp.

Conclusion

A dedicated orthopaedic surgery boot camp focused on clinical and technical skills plays a key role in increasing medical students’ confidence with key orthopaedic topics by providing an opportunity to practice these skills in a supervised environment with real-time feedback. This novel boot camp can provide a framework for creating a longitudinal course for medical students to augment the musculoskeletal education taught in medical school education.

Neurosurgery residency and fellowship education in the United States: 2 decades of system development by the One Neurosurgery Summit organizations

The purpose of this report is to chronicle a 2-decade period of educational innovation and improvement, as well as governance reform, across the specialty of neurological surgery. Neurological surgery educational and professional governance systems have evolved substantially over the past 2 decades with the goal of improving training outcomes, patient safety, and the quality of US neurosurgical care. Innovations during this period have included the following: creating a consensus national curriculum; standardizing the length and structure of neurosurgical training; introducing educational outcomes milestones and required case minimums; establishing national skills, safety, and professionalism courses; systematically accrediting subspecialty fellowships; expanding professional development for educators; promoting training in research; and coordinating policy and strategy through the cooperation of national stakeholder organizations. A series of education summits held between 2007 and 2009 restructured some aspects of neurosurgical residency training. Since 2010, ongoing meetings of the One Neurosurgery Summit have provided strategic coordination for specialty definition, neurosurgical education, public policy, and governance. The Summit now includes leadership representatives from the Society of Neurological Surgeons, the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the American Board of Neurological Surgery, the Review Committee for Neurological Surgery of the Accreditation Council for Graduate Medical Education, the American Academy of Neurological Surgery, and the AANS/CNS Joint Washington Committee. Together, these organizations have increased the effectiveness and efficiency of the specialty of neurosurgery in advancing educational best practices, aligning policymaking, and coordinating strategic planning in order to meet the highest standards of professionalism and promote public health.

The Development of a Video Intervention to Improve Senior Medical Students' Performance on Outpatient Telephone Encounters: a Delphi Analysis and Randomized Controlled Trial

Introduction

Postgraduate trainees address outpatient telephone calls (OTCs) with little prior training. This study determines the skills necessary for OTCs and examines whether a video intervention improves medical students' performance on simulated OTCs.

Materials and Methods

We utilized a Delphi technique to determine skills needed for OTCs and created a 9-min video teaching these skills. Senior medical students were randomized to Intervention (viewed video) and Control (did not view video) groups. Students were assessed pre-/post-intervention on simulated OTCs. The primary outcome was the between-group difference in improvement.

Results

The Delphi yielded 34 important skills with the highest focus on communication (n = 13) and triage (n = 6). Seventy-two students completed assessments (Control, n = 41; Intervention, n = 31). The score (mean ± SD) improved 4.3% in the Control group (62.3 ± 14.3% to 66.6 ± 25.0%) and 12.2% in the Intervention group (60.7 ± 15.2% to 72.9 ± 20.4%, p = 0.15). The effect size measured by Cohen's d was 0.55, considered effective (> 0.33) for an educational intervention.

Conclusions

This project fills a gap in OTC training. The use of the Delphi technique, intervention development based on the results, and evaluation of efficacy is a process that could be reproduced for other educational gaps.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-021-01331-w.

Residency Prep Course Instills Confidence in Interns

Introduction

Physicians entering surgical residency often feel unprepared for tasks expected of them beginning July 1, including responding to pages, writing orders, doing procedures independently, and a multitude of other requirements. Our aim was to design a surgical boot camp to help graduating senior medical students feel more confident entering residency.

Methods

A two-week intensive surgery residency prep course was conducted in the spring of 2019 at an Accreditation Council for Graduate Medical Education-accredited General Surgery residency program. The course was designed combining aspects from existing prep courses and innovative ideas tailored to resources available at our institution. Medical students participated in the Surgery Residency Prep Course as an elective at the end of their fourth year of medical school. An anonymous survey was given pre- and post-prep course completion evaluating confidence in medical knowledge, clinical skills, and surgical skills. Data were compared using Wilcoxon Signed-Rank Test.

Results

Six students completed the course as a medical elective. Students felt more confident at course completion in most aspects, were significantly more confident in all areas of surgical skills taught and evaluated, and nearly all areas of medical knowledge. Subjectively, students felt as though the course was beneficial and helped them feel more prepared for starting internship.

Conclusions

This course designed at our institution was successful in helping prepare and instill confidence in graduating medical students prior to starting their internship.

The Impact of Surgical Boot Camp and Subsequent Repetitive Practice on the Surgical Skills and Confidence of Residents

Background

Boot camp can enable residents to acquire surgical skills and confidence, but they can lose these skills over time if they do not use them. The purpose of this study was to explore whether boot camp and subsequent repetitive practice could strengthen residents’ clinical skills and self-confidence.

Methods

This is a comparative study of surgical residents who were enrolled in our institution from 2016 to 2017. The residents in the experimental group (enrolled in 2017) received boot camp training and a year of repetitive practice. The control group (enrolled in 2016) only received routine residency training. The rotation assessment pass rates of the two groups during the first year of the residency training were compared. A survey was conducted at different points in time to investigate the influence of boot camp and repetitive practice on the confidence of the residents.

Results

The assessment pass rate of the experimental group was significantly higher than that of the control group (p < 0.05). The residents’ confidence in themselves improved significantly after the boot camp, and it was comparable to that of the residents in the control group after their first year of residency. The level of self-confidence of the experimental group was further improved after repetitive practice. Finally, residents in the experimental group received better evaluations by their colleagues than the control group received.

Conclusions

This study showed that boot camp can improve the surgical skills and confidence of residents and that repetitive practice can further strengthen them. Residents in the experimental group developed their self-confidence in boot camp, and it increased after repetitive practice.

Self-reported confidence and perceived training needs of surgical interns at a regional hospital in Ghana: a questionnaire survey

BACKGROUND

Due to disparities in their regional distribution of the surgical specialists, those who have finished "housemanship," which is the equivalent of an internship, are serving as main surgical care providers in rural areas in Ghana. However, the quantitative volume of postgraduate surgical training experience and the level of self-reported confidence after formal training have not been investigated in detail in sub-Saharan Africa.

METHODS

The quality-assessment data of the Department of surgery at a regional hospital in Ghana was obtained from the convenience samples of house officers (HOs) who had their surgical rotation before July 2019. A self-reported questionnaire with 5-point Likert-type scale and open-ended responses regarding the 35 topics listed as learning objectives by the Medical and Dental Council of Ghana were retrospectively reviewed to investigate the volume of surgical experience, self-reported confidence, and perceived training needs.

RESULTS

Among 52 respondents, the median self-reported number of patients experienced for each condition was less than 11 cases. More than 40% of HOs reported that they had never experienced cases of liver tumor (n = 21, 40.4%), portal hypertension (n = 23, 44.2%), or cancer chemotherapy/cancer therapy (n = 26, 50.0%). The median self-confidence score was 3.69 (interquartile range, 3.04 ~ 4.08). More than 50% of HOs scored ≤2 points on the self-confidence scale of gastric cancer (n = 28, 53.8%), colorectal cancer (n = 31, 59.6%), liver tumors (n = 32, 61.5%), and cancer chemotherapy/cancer therapy (n = 38, 73.1%). The top 3 reasons for not feeling confident were the limited number of patients (n = 42, 80.8%), resources and infrastructure (n = 21, 40.4%), and amount of supervision (n = 18, 34.6%). Eighteen HOs (34.6%) rated their confidence in their surgical skills as ≤2 points. Of all respondents, 76.9% (n = 40) were satisfied with their surgical rotation and 84.6% (n = 44) perceived the surgical rotation as relevant to their future work. Improved basic surgical skills training (n = 27, 51.9%) and improved supervision (n = 18, 34.6%) were suggested as a means to improve surgical rotation.

CONCLUSIONS

Surgical rotation during housemanship (internship) should be improved in terms of cancer treatment, surgical skills, and supervision to improve the quality of training, which is closely related to the quality of surgical care in rural areas.

Development of a program for teaching practical skills in visceral and digestive surgery by simulation

Up until 2013 in France, practical training for DES/DESC (advanced level) residents in visceral and digestive surgery was not standardized. Since 2017, the third cycle of medical studies has been restructured around three major thematic axes: academic knowledge, and technical and non-technical skills. The curriculum now includes a practical training program by means of simulation outside the operating theater, and it is structured, uniformized and standardized nationwide. Development of this training program is derived from the deliberations of a national consensus panel working under the umbrella of the French college of visceral and digestive surgery, program presenting a training guide to all future surgeons in the specialty. Four consensus conference sessions bringing together an eight-member commission have led to the drafting of a "Resident's manual for practical teaching in visceral and digestive surgery". As a reference document, the manual details in 272 pages the objectives (phase I), the learning resources for each skill (phase II) and, lastly, the means of evaluation for the cornerstone phases as well as the in-depth phases of an advanced degree (DES) in visceral and digestive surgery. As a complement to the manual, we have conducted a review of the structuring and implementation of the program as of November 2017 on a nationwide scale; the conclusions of the review are detailed at the end of this article.

Simulation Training to Improve the Ability of First-Year Doctors to Assess and Manage Deteriorating Patients: a Systematic Review and Meta-analysis

Many simulation courses now exist which aim to prepare first-year doctors for the task of assessing and managing potentially deteriorating patients. Despite the substantial resources required, the degree to which participants benefit from such courses, and which aspects of the simulation training are optimal for learning, remains unclear. A systematic literature search was undertaken across seven electronic databases. Inclusion criteria were that the intervention must be a simulation of a deteriorating patient scenario that would likely be experienced by first-year doctors, and that participants being first-year doctors or in their final year of medical school. Studies reporting quantitative benefits of simulation on participants' knowledge and simulator performance underwent meta-analyses. The search returned 1444 articles, of which 48 met inclusion criteria. All studies showed a benefit of simulation training, but outcomes were largely limited to self-rated or objective tests of knowledge, or simulator performance. The meta-analysis demonstrated that simulation improved participant performance by 16% as assessed by structured observation of a simulated scenario, and participant knowledge by 7% as assessed by written assessments. A mixed-methods analysis found conflicting evidence about which aspects of simulation were optimal for learning. The results of the review indicate that simulation is an important tool to improve first-year doctors' confidence, knowledge and simulator performance with regard to assessment and management of a potentially deteriorating patient. Future research should now seek to clarify the extent to which these improvements translate into clinical practice, and which aspects of simulation are best suited to achieve this.

A Method to Evaluate Trainee Progression During Simulation Training at the Urology Simulation Boot Camp (USBC) Course

OBJECTIVES

To evaluate skills progression at the Urology Simulation Boot Camp (USBC), a course intended to provide urology trainees with 32 hours of 1:1 training on low and high-fidelity simulators.

DESIGN

In this single-group cohort study, trainees rotated through modules based on aspects of the United Kingdom urology residency curriculum and undertook a pre and postcourse MCQ. Specific procedural skill was evaluated by an expert and graded as either: "A"-Good (≥4 on a 5-point Likert Scale) or "B"-Poor (Likert scale of 1-3). Competence progression was calculated as the change in score between baseline and final assessments.

SETTING

The USBC was held at St James' University Hospital, Leeds, U.K.

PARTICIPANTS

Of the 34 trainees attended the second USBC, 33 trainees participated in all the pre and postcourse assessments. The mean duration of urology training prior to undertaking the USBC was 15 months.

RESULTS

Competence progression was assessed in 33 urology trainees. Mean MCQ scores improved by 16.7% (p < 0.001) between pre and postcourse assessment. At final assessment, 87.9% of trainees scored "A" in instrument knowledge and assembly compared to 44.4% at baseline (p < 0.001). There was a mean improvement of 439s (p < 0.001) in the time taken to complete the European-Basic Laparoscopic skills assessment.

CONCLUSIONS

The USBC has shown to aid trainees in competence progression during the simulation on a variety of urological skills; however, retention of skill in the long-term was undetermined. The use of our grading system is simple to understand and may be used in other simulation courses to guide participants with their future training needs.

A novel, low-cost, reusable, high-fidelity neurosurgical training simulator for cerebrovascular bypass surgery

OBJECTIVE

Cerebrovascular bypass surgery is a challenging yet important neurosurgical procedure that is performed to restore circulation in the treatment of carotid occlusive diseases, giant/complex aneurysms, and skull base tumors. It requires advanced microsurgical skills and dedicated training in microsurgical techniques. Most available training tools, however, either lack the realism of the actual bypass surgery (e.g., artificial vessel, chicken wing models) or require special facilities and regulations (e.g., cadaver, live animal, placenta models). The aim of the present study was to design a readily accessible, realistic, easy-to-build, reusable, and high-fidelity simulator to train neurosurgeons or trainees on vascular anastomosis techniques even in the operating room.

METHODS

The authors used an anatomical skull and brain model, artificial vessels, and a water pump to simulate both extracranial and intracranial circulations. They demonstrated the step-by-step preparation of the bypass simulator using readily available and affordable equipment and consumables.

RESULTS

All necessary steps of a superficial temporal artery-middle cerebral artery bypass surgery (from skin opening to skin closure) were performed on the simulator under a surgical microscope. The simulator was used by both experienced neurosurgeons and trainees. Feedback survey results from the participants of the microsurgery course suggested that the model is superior to existing microanastomosis training kits in simulating real surgery conditions (e.g., depth, blood flow, anatomical constraints) and holds promise for widespread use in neurosurgical training.

CONCLUSIONS

With no requirement for specialized laboratory facilities and regulations, this novel, low-cost, reusable, high-fidelity simulator can be readily constructed and used for neurosurgical training with various scenarios and modifications.

Surgical Practical Skills Learning Curriculum: Implementation and Interns' Confidence Perceptions

OBJECTIVE

To provide an overview of the practical skills learning curriculum and assess its effects over time on the surgical interns' perceptions of their technical skills, patient management, administrative tasks, and knowledge.

DESIGN

An 84-hour practical skills curriculum composed of didactic, simulation, and practical sessions was implemented during the 2015 to 2016 academic year for general surgery interns. Totally, 40% of the sessions were held during orientation, whereas the remainder sessions were held throughout the academic year. Interns' perceptions of their technical skills, administrative tasks, patient management, and knowledge were assessed by the practical skills curriculum residents' perception survey at various time points during their intern year (baseline, midpoint, and final). Interns were also asked to fill out an evaluation survey at the completion of each session to obtain feedback on the curriculum.

SETTING

General Surgery Residency program at a tertiary care academic institution.

PARTICIPANTS

20 General Surgery categorical and preliminary interns.

RESULTS

Significant differences were found over time in interns' perceptions on their technical skills, patient management, administrative tasks, and knowledge (p < 0.001 for all). The results were also statistically significant when accounting for a prior boot camp course in medical school, intern status (categorical or preliminary), and gender (p < 0.05 for all). Differences in interns' perceptions occurred both from baseline to midpoint, and from midpoint to final time point evaluations (p < 0.001 for all). Prior surgical boot camp in medical school status, intern status (categorical vs. preliminary), and gender did not differ in the interns' baseline perceptions of their technical skills, patient management, administrative tasks, and knowledge (p > 0.05 for all).

CONCLUSIONS

Implementation of a Practical Skills Curriculum in surgical internships can improve interns' confidence perception on their technical skills, patient management skills, administrative tasks, and knowledge.

A one-day surgical-skill training course for medical students' improved surgical skills and increased interest in surgery as a career

BACKGROUND

Despite many high-quality programs in basic surgical-skill education, the surgical skill of junior doctors varies widely. This, together with the waning interest in surgery as a career among medical students, is a serious issue confronted by hospitals and healthcare systems worldwide. We, therefore, developed and implemented an intensive one-day surgical-skill training course for two purposes; it would improve surgical skills and increase interest in surgery among medical students.

METHODS

The surgical-skill training program is named Surgical Skill Weekend (SSW) and it includes hands-on training sessions for surgical-suturing techniques and advanced surgical procedures (i.e. laparoscopic and robot-assisted surgery), hybrid simulation sessions, and an operating-room session where aforementioned sessions are all put together. By the end of the program, students' improvements in surgical-suturing skills were assessed by experts in a form of checklist, and changes in the interest in a surgical career, if there were any, were answered by the students who participated in the program.

RESULTS

A total of ninety-one (91) medical students participated in the 2015 and 2016 SSW courses. Their overall satisfaction level with the course was very high (Very satisfied: 78%, Quite satisfied: 22%). All of the participant's surgical-suturing skills significantly improved (median score range: 14-20, P < 0.05) and their interest in a surgical career increased significantly (from 56% to 81%, P < 0.05) by completing the program.

CONCLUSIONS

An intensive and comprehensive surgical-skill training program for medical students can not only improve surgical-suturing skills but also increase interest in surgery as a career.

At Home Preresidency Preparation for General Surgery Internship: A Pilot Study

OBJECTIVE

To create a novel "at-home" preresidency preparatory adjunct for medical students entering surgical residency.

DESIGN

Preparatory resources were mailed to match medical students before residency matriculation in 2015. This included "how-to" videos, low-cost models, and surgical instruments for 5 "stations" (arterial blood gas analysis, anatomy and imaging knowledge, knot tying ability, and suturing dexterity) of our program's biannual general surgery intern objective assessment activity (Surgical Olympics: total 13 stations, 10 points each). Scores from 2015 were compared with 2014 historical controls in a retrospective manner using the Student's t-test.

SETTING

Academic, tertiary care referral center with a large general surgery training program.

PARTICIPANTS

Postgraduate year 1 general surgery trainees (interns) from the years 2014 and 2015.

RESULTS

Twenty-six interns participated in the 2015 assessment and were compared to thirty-two 2014 interns. Overall mean scores were low, but higher (19.7 vs. 15.4, p = 0.04) in the 2015 class. The largest increase was noted in the anatomy knowledge station (mean = 5.0 vs. 1.9, p < 0.01). Scores in stations assessing technical competence were similar to controls. The number of perfect scores among the 5 stations was higher (10 vs. 5) in the 2015 group. Mean scores from the other 8 stations, for which no resources were mailed, showed no difference (29.3 vs. 28.3, p = 0.75).

CONCLUSIONS

Enacting a simple, home-based curriculum for medical students before surgical residency, improved performance on early knowledge assessments.

Learning outcomes evaluation of a simulation-based introductory course to anaesthesia

OBJECTIVE

An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated.

MATERIAL AND METHOD

Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed.

RESULTS

Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues.

CONCLUSIONS

A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization.

40-4-40: educational and economic outcomes of a free, international surgical training event

PURPOSE OF STUDY

To demonstrate a model for delivery of an international surgical training event, and demonstrate its educational and economic outcomes.

STUDY DESIGN

The Association of Surgeons in Training (ASiT) ran a course series on 16 January 2016 across the UK and Ireland. A mandatory, self-reported, online questionnaire collected delegate feedback, using 5-point Likert Scales, and a NetPromoter feedback tool. Precourse and postcourse matched questionnaires were collected for 'Foundation Skills in Surgery' (FSS) courses. Paired economic analysis was performed. Statistical analysis was carried out using RStudio (V.3.1.1 Boston, Massachusetts, USA).

RESULTS

Forty courses were held across the UK and Ireland (65.0% technical, 35.0% non-technical), with 184 faculty members. Of 570 delegates, 529 fully completed the feedback survey (92.8% response rate); 56.5% were male. The median age was 26 years (range: 18-67 years). The mean overall course NetPromoter Score was 8.7 out of 10. On logistic regression high NetPromoter Score was associated with completing a Foundation Skills in Surgery course (R=0.44, OR: 1.49, p=0.025) and having clear learning outcomes (R=0.72, OR: 2.04, p=0.029) but not associated with specialty, course style or teaching style. For Foundation Skills in Surgery courses, delegates reported increased commitment to a career in surgery (p<0.001), confidence with basic surgical skills (p<0.001) and confidence with assisting in theatre (p<0.001). A comparable cost saving of £231,462.37 was calculated across the 40 courses.

CONCLUSION

The ASiT '40-4-40' event demonstrated the diversity and depth of surgical training, with 40 synchronous technical and non-technical courses, demonstrable educational benefit and a significant cost saving to surgical trainees.

Medical School Surgical Boot Camps: A Systematic Review

PURPOSE

Many medical schools have begun to offer surgical boot camps to senior medical students. The aim of the present study is to systematically review the literature and evidence surrounding medical school surgical boot camps to direct future research into the effectiveness of boot camps.

METHODS

A systematic review was conducted, searching MEDLINE, EMBASE, PsycINFO, CINAHL, and ERIC. The review was conducted according to the PICOTS structure, with an intervention of a surgical boot camp for senior medical students entering surgical residencies.

RESULTS

The search resulted in 5351 database hits, from which we identified 10 published studies that met the inclusion criteria. Two reviews were identified that met the PICOTS criteria but were excluded from data synthesis. Boot camps increase the confidence and competence of medical students entering their surgical internships. There is no objective assessment of the effect of boot camps on the clinical performance of interns.

CONCLUSIONS

Despite the success of medical school surgical boot camps, no objective data exist to show that boot camps translate into improved performance during internship.

Simulation research to enhance patient safety and outcomes: recommendations of the Simnovate Patient Safety Domain Group

The use of simulation-based training has established itself in healthcare but its implementation has been varied and mostly limited to technical and non-technical skills training. This article discusses the possibilities of the use of simulation as part of an overarching approach to improving patient safety, and represents the views of the Simnovate Patient Safety Domain Group, an international multidisciplinary expert group dedicated to the improvement of patient safety. The application and integration of simulation into the various facets of a learning healthcare system is discussed, with reference to relevant literature and the different modalities of simulation which may be employed. The selection and standardisation of outcomes is highlighted as a key goal if the evidence base for simulation-based patient safety interventions is to be strengthened. This may be achieved through the establishment of standardised reporting criteria. If such safety interventions can be proven to be effective, financial incentives are likely to be necessary to promote their uptake, with the intention that up-front cost to payers or insurers be recouped in the longer term but reductions in complications and lengths of stay.

A Pediatric Cardiology Fellowship Boot Camp improves trainee confidence

Introduction New paediatric cardiology trainees are required to rapidly assimilate knowledge and gain clinical skills to which they have limited or no exposure during residency. The Pediatric Cardiology Fellowship Boot Camp (PCBC) at Boston Children's Hospital was designed to provide incoming fellows with an intensive exposure to congenital cardiac pathology and a broad overview of major areas of paediatric cardiology practice.

METHODS

The PCBC curriculum was designed by core faculty in cardiac pathology, echocardiography, electrophysiology, interventional cardiology, exercise physiology, and cardiac intensive care. Individual faculty contributed learning objectives, which were refined by fellowship directors and used to build a programme of didactics, hands-on/simulation-based activities, and self-guided learning opportunities.

RESULTS

A total of 16 incoming fellows participated in the 4-week boot camp, with no concurrent clinical responsibilities, over 2 years. On the basis of pre- and post-PCBC surveys, 80% of trainees strongly agreed that they felt more prepared for clinical responsibilities, and a similar percentage felt that PCBC should be offered to future incoming fellows. Fellows showed significant increase in their confidence in all specific knowledge and skills related to the learning objectives. Fellows rated hands-on learning experiences and simulation-based exercises most highly.

CONCLUSIONS

We describe a novel 4-week-long boot camp designed to expose incoming paediatric cardiology fellows to the broad spectrum of knowledge and skills required for the practice of paediatric cardiology. The experience increased trainee confidence and sense of preparedness to begin fellowship-related responsibilities. Given that highly interactive activities were rated most highly, boot camps in paediatric cardiology should strongly emphasise these elements.

Procedural Experience and Confidence Among Graduating Medical Students

OBJECTIVE

Bedside procedures are a vital component of patient care-particularly for surgeons. Anecdotal evidence and previous studies from individual institutions reveal a lack of exposure to these interventions in medical school. Our objective was to ascertain medical students' experience and confidence in performing bedside procedures.

DESIGN

Our study included a multi-institutional, anonymous, Health Insurance Portability and Accountability Act-compliant electronic survey. Using a 4-point Likert scale, students were asked how many times they had performed each of 18 common bedside procedures and their anticipated confidence in completing it independently. Statistical analysis included student t test, Chi-square test, analysis of means, linear regression, and Bonferroni correction for multiple comparisons.

PARTICIPANTS

In total, participants included 2260 4th year medical students at 17 allopathic medical schools.

RESULTS

Overall, 644 students replied (28.5% response rate). Most respondents had never placed an arterial line (71%), central venous line (81%), chest tube (89%), intraosseous line (95%), injected a joint (63%), or had performed cardiopulmonary resuscitation (50%), a lumbar puncture (57%), paracentesis (66%), or thoracentesis (92%). Venipuncture, suturing, and Foley catheter placement were the only procedures which greater than 50% of students had performed more than 5 times. Significant correlation was observed (r = 0.7) between experience and confidence, with men being reported significantly higher experience and confidence than women (p < 0.0001). Students entering anesthesia and emergency medicine residencies reported significantly higher experience than those matriculating into other specialties (α = 0.003); students entering emergency medicine and surgery reported significantly higher confidence levels (α = 0.003).

CONCLUSION

The largest survey of its kind, the present study demonstrates that medical students are underexposed to essential bedside procedures and feel uncomfortable performing them-a trend that has worsened over 25 years. Students entering surgical specialties have significantly higher levels of confidence, although a corresponding difference in experience was not observed.