Effects of Postgraduate Medical Education "Boot Camps" on Clinical Skills, Knowledge, and Confidence: A Meta-Analysis

The Relationship between Pediatric Medical Training and Neonatal Care in the Delivery Room and Beyond

The modern neonate differs greatly from newborns cared for a half-century ago, when the neonatal-perinatal medicine certification examination was first offered by the American Board of Pediatrics. Delivery room resuscitation and neonatal care are constantly evolving, as is the neonatal workforce. Similarly, the Accreditation Council for Graduate Medical Education review committees revise the requirements for graduate medical education programs every 10 years, and the modern pediatric medical trainee is also constantly evolving. Delivery room resuscitation, neonatal care, and pediatric residency training are codependent; changes in one affect the other and subsequently influence neonatal outcomes. In this educational perspective, we explore this relationship and outline strategies to mitigate the impact of decreased residency training in neonatal-perinatal medicine.

Designing, implementing, and evaluating a basic surgical skills bootcamp: An effective approach to enhance competency in surgical residency training

INTRODUCTION

Recent technological advances have facilitated the development of new educational methods, such as simulation-based learning, in specialized bootcamps to enhance the learning of surgical residents. This study aimed to design, implement, and evaluate a basic surgical skills bootcamp for residents in general surgery, orthopedics, neurosurgery, and gynecology based on the learning gap in the current educational program.

METHODS

This intervention study focused on the design, implementation, and evaluation of a basic surgical skills bootcamp in a simulated operating room for first-year surgical residents in general surgery, orthopedics, neurosurgery, and gynecology.

RESULTS

The study resulted in the creation of a comprehensive course plan and the execution of a 6-day training program. Evaluation of educational outcomes confirmed high learner satisfaction, improvement in Multiple Choice Questions (MCQ) exam scores, and acceptable scores in the Objective Structured Clinical Examination (OSCE).

CONCLUSION

The findings of this study suggest that surgical bootcamps, when designed based on needs assessment and in line with scientific bootcamp design principles, play a crucial role in enhancing the satisfaction, knowledge, and skills of surgical residents.

Does a junior doctor focused 'Bootcamp' improve the confidence and preparedness of newly appointed ENT registrars to perform their job roles?

BACKGROUND

To assess changes in confidence and preparedness after conducting a 2-day induction bootcamp for novice Ear Nose and Throat (ENT) first year specialty trainee registrars (ST3s) in the United Kingdom (UK). The bootcamp covered common ENT presentations on the ward, and in the elective and emergency settings.

METHODS

A total of 32 trainees (ST3 or research fellow) voluntarily registered via an online application form to the Southern ST3 accelerated learning course bootcamp through ENT UK. ENT UK is a membership body that supports ENT trainees throughout their careers. They completed a two-day bootcamp that was hosted at St Mary's Hospital, London and 10 skills sessions were delivered by either a senior ENT registrar or an ENT consultant. A pre-session questionnaire was distributed to all participants and a post-session questionnaire was provided that assessed the changes in confidence and preparedness of the participants, if any. The responses were scored by a 10-point Likert scale. Only participants who fully completed the pre and post questionnaire were included, which was 29 in total.

RESULTS

Participants self-reported a significant increase in confidence (p < 0.001) and preparedness (p < 0.001) following the bootcamp course. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station.

CONCLUSION

The use of a two-day bootcamp improved confidence and preparedness of managing common ENT presentations in the ward, elective and emergency settings for ENT ST3s. It provides a useful adjunct in the acquisition of technical and non-technical skills alongside the traditional surgical apprenticeship. In the future, more work is required to assess the impact of bootcamps on patient outcomes and long-term benefits on trainees' skill retention and clinical proficiency.

Learning needs of junior doctors in otolaryngology: a qualitative study

OBJECTIVES

There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs.

METHOD

Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians.

RESULTS

The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts.

CONCLUSION

All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.

Pilot Study: Developing Curriculum to Prepare Fourth-Year Medical Students Applying for OBGYN Residency Within the Defense Health Agency

BACKGROUND

Obstetrics and gynecology (OBGYN) is becoming increasingly competitive among medical specialties. As a result, many medical schools have frameworks to help their students increase their competitiveness to maximize chances of a successful match. However, "boot camps" have traditionally been geared toward the transition to intern year and not to sub-internships during the fourth year of medical school. We aimed to develop a boot camp for rising fourth-year medical students planning to apply into OBGYN before the initiation of their sub-internships and interview season.

METHODS

Sixteen students enrolled in this course led by faculty OBGYNs at our institution. We utilized a combination of mentorship, coaching, and education to achieve applicant success. The curriculum included formal lectures, surgical skills training, and focused feedback from our applicant development committee.

RESULTS

Our response rate was 100% and 94% for the pre-intervention and post-intervention survey, respectively. Before the intervention, the majority of participants felt either neutral (47.4%) or unprepared (21.1%) regarding their knowledge before their sub-internships. However, after the intervention, all reported feeling more prepared for their rotations. All respondents either agreed (60%) or strongly agreed (40%) that the course increased their confidence in performing well on audition rotations. Our match rate increased from 62% for the class of 2022 (before this intervention) to 75% for the class of 2023.

DISCUSSION

In light of the increasing residency match competitiveness, it is crucial to investigate programs that can assist students in developing stronger applications. This reproducible intervention utilizes few resources and can be implemented at most medical schools to better support their OBGYN applicants.

Simulation-Based Education in US Undergraduate Medical Education: A Descriptive Study

PURPOSE

Simulation-based education (SBE) provides experiential learning, improvement in quality of care, and reduction in errors. In 2011, the Association of American Medical Colleges described adoption of SBE in 68.0% of medical schools and 25.0% of teaching hospitals. We sought to examine current trends of SBE integration in American undergraduate medical education since previous publications.

METHODS

From 2016 to 2019, University of Texas Southwestern Medical Center postgraduate year 1 residents were invited to participate in a survey assessing medical school simulation experience with 26 clinical tasks from three categories: procedural, communication, and other. Deidentified results were analyzed to assess demographics including sex, specialty, residency program type, allopathic versus osteopathic medical school, and medical school region.

RESULTS

Nine hundred sixty-seven of 1047 (92.3%) responses were obtained, representing 139 US medical schools, 91% from allopathic training. Of procedural tasks, most simulated was suturing (n = 848, 89.6%) and least simulated was thoracentesis (n = 737, 80.9%). Of communication tasks, most simulated was taking a history (n = 475, 51.1% reporting simulation >30) and least simulated (never or ≤1) were obtaining a consent (n = 669, 73.2%) and disclosing a medical error (n = 666, 72.4%). Of other tasks, most simulated was chest compressions (n = 898, 96.0%) and least simulated was operating a defibrillator (n = 206, 22.1%). Results were similar regardless of procedural or nonprocedural program. There was no significant difference in SBE exposure between allopathic and osteopathic students ( P = 0.89). Two participants (0.002%) reported no simulation exposure.

CONCLUSIONS

Our study is the first to describe a high prevalence of SBE adoption in medical schools nationwide since the Association of American Medical Colleges' 2011 publication, with overall equal exposure for students regardless of residency type and allopathic or osteopathic medical school. Despite widespread adoption of simulation, opportunities remain to expand SBE use to teach critically important communication skills.

Ready Day One: What Residents and Program Directors Think is Needed for a Successful Transition to Residency

OBJECTIVE

To evaluate perceived gaps in preparedness, current on-boarding practices, and need for specialty wide resources in the transition to residency training in obstetrics and gynecology (OB/GYN) DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey of current U.S. OB/GYN residents and program directors (PDs) at the time of the resident in-training exam was conducted in 2022. Both groups provide demographic information and identified specific knowledge, skills, and abilities in need of more preparation at the start of residency. PDs were queried on perceptions of readiness for their current first year class, educational on-boarding practices, and their preference for standardized curricular materials and assessment tools. Chi-squared and Kruskal-Wallis tests were used to compare perceptions of skills deficits between PDs and residents, and the relationship of preparedness to program type and resident year in training.

RESULTS

Response rates for residents and program directors were 64.9% and 72.6% respectively. A majority (115/200, 57.5%) of program directors agreed or strongly agreed with the statement, "In general, I feel that my new interns are well prepared for residency when they arrive at my program." Both groups agreed that basic suturing and ultrasound skills were deficits. Residents identified a need for better preparation in management of inpatient issues while PDs identified time management skills as lacking. There was considerable heterogeneity of program on-boarding practices across the specialty. Most PDs agreed or strongly agreed that a standardized curriculum (80.5%, 161/200) and assessment tools (75.3%, 150/199) would be helpful.

CONCLUSION

OBGYN PDs feel that not all residents arrive prepared for residency and overwhelmingly support the development of standardized transition curricular and assessment tools, similar to the curriculum developed in general surgery. Based on input from PDs and residents, early curricular efforts should focus on basic surgical, ultrasound, and time management skills and on management of inpatient issues.

Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability

BACKGROUND

The effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated.

METHODS

A prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student's communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT).

RESULTS

Fifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)].

CONCLUSION

Simulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.

The Montreal Plastic Surgery Residency Bootcamp: Structure and Utility

Transitioning from medical school to surgical residency is a difficult endeavor. To facilitate this period, the University of Montreal's plastic surgery program developed and implemented an intensive 1-month bootcamp rotation. It is the only one of its kind and length amongst plastic surgery residency programs in North America. It includes didactic teachings in anatomy, cadaveric dissections, and surgical approaches for an array of procedures. Clinical and technical skills are reviewed with senior residents and attending surgeons. Research opportunities and case scenarios are also covered. An anonymous online 30-question survey was sent to all residents who participated in the bootcamp rotation between 2013 and 2020. Questions evaluated residents' knowledge of anatomy, basic surgical skills, common approaches, flap knowledge, and on-call case management, before and after the bootcamp. Seventeen plastic surgery residents responded to this questionnaire (81%). The majority confirmed that the bootcamp helped them prepare for residency, research, and on-calls, and also helped them expand their knowledge of anatomy and surgical skills. The residents responded positively to the bootcamp's structure and implementation. This study proposes that surgical programs could benefit from a bootcamp rotation at the beginning of their curriculum. The purpose is to facilitate the transition between medical school and postgraduate training, and to ensure a basic level of competence for all junior residents. Further prospective studies could demonstrate the bootcamp's impact in board certification rates and acceptance into fellowship training programs.

Urology boot camp for medical students: Using virtual technology to enhance undergraduate education

Objectives

The study aims to describe the methodology of converting the urology boot camp for medical students into a virtual course with key take home points for a successful conversion and to present quantitative and qualitative data demonstrating the impact of the boot camp on improving delegates' knowledge and clinical acumen.

Materials and methods

The face-to-face boot camp was converted to a virtual format employing a variety of techniques including; utilizing an online platform to deliver live screened lectures, using online polling software to foster an interactive learning environment and displaying pre-recorded videos to teach practical skills. Validated Multiple Choice Questionnaires (MCQs) were used prior to and after the course. This enabled the assessment of delegates' knowledge of urology according to the national undergraduate curriculum, and paired t tests were used to quantify the level of improvement. Thematic analysis was carried out on post-course delegate feedback to identify highlights of the course and ways of improving future iterations.

Results

In total, 131 delegates took part in the pilot virtual course. Of these, 105 delegates completed the pre- and post-course MCQs. There was a statistically significant improvement in the assessment following the course (p = <0.001) with mean score increasing from 47.5% pre-course to 65.8% post-course. All delegates who attended the most recent implementation of the virtual course (n = 31) felt it improved their knowledge and confidence in urology. Twenty delegates (64.5%) felt that it prepared them for both final year medical school examinations and working as a foundation year doctor. Positive themes in feedback were identified, which included the interactive nature of the course, the quality of teaching, the level and content of information provided and the high yield, concise organization of the teaching schedule.

Conclusion

Using virtual technology and innovative educational frameworks, we have demonstrated the successful conversion of the urology boot camp for medical students to a virtual format. At a national level, with support from the British Association of Urological Surgeons, the face-to-face component of the course will continue to run in parallel with the virtual course with the aim of standardizing and improving UK undergraduate urological education. The virtual course has been implemented on an international scale, and this has already shown promising results.

Self-Reported Perceptions of Preparedness among Incoming Ophthalmology Residents

Purpose  The purpose of this study was to assess the self-perceived preparedness of incoming postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) ophthalmology interns/residents to carry out core competencies in ophthalmology. Methods  An online survey was created using the Survey Monkey survey platform and distributed to all ophthalmology resident applicants to the Bascom Palmer Eye Institute from the 2021 to 2022 and 2022 to 2023 application cycles. The survey contained questions pertaining to demographics, prior ophthalmic experience, online resources that were used to prepare for ophthalmology, and self-perceived preparedness to carry out key clinical skills in ophthalmology. Results  A total of 170 responses were obtained (16.1% response rate). Of those, 119 (70%) were incoming PGY1 interns and 51 (30%) were incoming PGY2 residents for the 2022 to 2023 academic year. Most respondents (90.6%, n  = 154) reported that their ophthalmology residency was affiliated with an integrated ophthalmology intern year. Incoming PGY2s moderately agreed with the statement that they felt as prepared to see patients in ophthalmology as they do in other surgical subspecialties, whereas incoming PGY1s only mildly agreed with that statement ( p  = 0.003). Both incoming PGY1s and PGY2s felt most prepared to obtain histories relating to basic ophthalmic complaints and felt least prepared to read and interpret ophthalmic imaging studies. The most popular online resources used by respondents in order of popularity were EyeGuru (35.2%, n  = 60), EyeWiki (32.9%, n  = 56), Tim Root/OphthoBook (26.5%, n  = 45), American Academy of Ophthalmology (13.5%, n  = 23), and EyeRounds/University of Iowa (13.5%, n  = 23). Conclusion  A major challenge in integrating ophthalmic education into the medical school curricula is the gradual shift toward shorter preclinical curricula. However, having a core foundation of ophthalmic knowledge is critical for incoming ophthalmology residents to be able to maximize their specialty-specific training. Integrated ophthalmology intern years likely play a significant role in the increased self-efficacy of incoming PGY2s compared with incoming PGY1s. Adopting nontraditional teaching methods like flipped classroom learning, utilizing online medical education resources, and continuing to increase ophthalmology exposure during PGY1 year may better prepare incoming PGY2s to operate independently in ophthalmology settings.

A Qualitative Analysis of Assessment and Evaluation Practices Within the Individualized Curriculum

OBJECTIVE

The Accreditation Council of Graduate Medical Education requires an "individualized curriculum" (IC) in pediatric residency. A shared understanding across programs of methods to evaluate the IC is lacking. We explored pediatric program leaders' perceptions of assessment and evaluation within the IC to further understand and inform most useful practices.

METHODS

We conducted a phenomenology study using semi-structured interviews to 1) determine what IC assessment and evaluation strategies are utilized in pediatric residency programs, and 2) explore program leaders' perceptions of the feasibility and value of assessment and evaluation in the IC. We recruited a purposive sample of leaders from 15 pediatric residency programs of various sizes and regions. Interviews were recorded and transcribed. Data were analyzed to produce themes.

RESULTS

Three themes arose from our analysis: 1) Systematic assessment of the IC, though desired, is not robust in pediatric residency training; 2) Program differences present unique barriers and facilitators that impact the feasibility of assessment within the IC; and 3) Meaningfulness of assessment in the IC varies by stakeholder. Themes reflected perspectives on individual learner assessment and program evaluation.

CONCLUSIONS

While systematic assessment and evaluation of the IC in pediatric residency training is lacking, program leaders desire feasible strategies that are meaningful to the resident, the program, and its leadership team. Leveraging current assessment and evaluation tools and aligning new assessment strategies could promote the integration of IC assessment with other assessments, minimizing burden. More structured IC assessment and evaluation could inform how to best achieve curricular goals of the IC.

Why confidence leads to swifter tertiary education choices: A qualitative study of the international tertiary education industry of Australia

This paper investigates international students' confidence as a base for imminent tertiary education decisions. International students are a highly sought-after commodity, particularly during and after a global pandemic when the income streams of tertiary education providers are limited. In-depth interviews were conducted with students who sought guidance towards an international study experience to explore the guiding research questions, (1) how does confidence impact tertiary education decisions of international students and (2) what is the relationship between confidence and time to make a tertiary education decision? Set within the context of the international tertiary education industry of Australia, the original contribution stems from identifying that guidance towards an international study experience is affected by confidence in; guidance counselors, the brand name of the university, and the tertiary education decision itself. The identified confidence characteristics in this study have an inverse relationship with the length of time taken for the students' decision-making process. This leads to swifter finalizations of tertiary education decisions by students increasing returns on education providers' admission activities.

Development and Optimization of a Remote Pediatric Cardiac Critical Care Bootcamp Using Telesimulation

We developed a novel cardiac critical care bootcamp consisting of didactic, small group, and simulation sessions. The bootcamp was remote due to the COVID-19 pandemic and included telesimulation. We aimed to assess learners' reactions to the bootcamp and their perception of telesimulation. Paired anonymous surveys were administered before and after participation. Surveys assessed participants' comfort in independently managing cardiac critical care scenarios, perceptions of telesimulation, barriers to its effectiveness, and specific feedback on course components. Forty-three fellows from 10 institutions joined the bootcamp over 2 years. Thirty-eight pre- and 28 postcourse surveys were completed. The course was rated good or excellent by all respondents, and 27/28 rated the material as appropriate to their level of training. Based on feedback from 2020, the electrophysiology sessions were converted to a small group format in 2021; positive assessment of these sessions improved from 65 to 90–100%. The telesimulations were highly rated, with 83–94% of participants in 2020 and 90–100% in 2021 rating them as good or excellent. Participants' views on telesimulation improved following the course, with 78% (14/18) post- versus 50% preparticipation agreeing that telesimulation is an effective educational tool (p = 0.06) and 56% (10/18) post- versus 67% (12/18) pre-rating telesimulation as less effective than in person simulation (p = 0.04). Identified limitations of telesimulation were limited active participation, lack of realism, impaired flow of conversation, and audiovisual and technical concerns. Telesimulation is feasible in cardiac critical care education and was an acceptable alternative to in person simulation for course participants.

Healthcare providers have insufficient up-to-date knowledge of lower limb sports injuries, and their knowledge is similar to that of athletes

BACKGROUND

Being up-to-date with evidence-based knowledge of lower limb sports injuries is essential for Healthcare professionals (HCPs).

PURPOSE

To assess whether HCPs possess up-to-date knowledge of lower limb sports injuries by comparing their knowledge to that of athletes.

METHODS

With an expert panel, we developed an online quiz of 10 multiple-choice questions on various topics related to lower-limb sports injuries. Maximal score was 100. We used social media to invite HCPs (5 groups: Physiotherapists, Chiropractors, Medical Doctors, Trainers, and Other therapists) and athletes of all levels (amateur, semi-pro, and pro) to participate. We drafted the questions according to conclusions from the latest systematic reviews and meta-analyses.

RESULTS

1526 participants completed the study. Final quiz scores ranged from zero (n = 28, 1.8%) to 100 (n = 2, 0.1%) and were distributed normally with a mean score of 45.4 ± 20.6. None of the 6 groups' means surpassed the set threshold of 60 points. Multiple linear regressions of covariates indicated that age, gender, engagement in physical activity, learning hours per week, reading scientific journals, reading popular magazines and blogs, trainers, and other therapists' groups explained 19% of the variances (-5.914<β < 15.082, 0.000<p < 0.038).

CONCLUSIONS

HCPs have insufficient up-to-date knowledge of lower limb sports injuries, and their knowledge is similar to that of athletes of all levels. HCPs probably do not possess the proper tools to assess scientific literature Academic and sports medicine societies should look into ways to improve the scientific knowledge integration of HCPs.

The need for a course to complete urological education for consultant practice using a simulated 'boot camp' structure at the end of specialist training: A survey-based study

BACKGROUND AND AIMS

To obtain opinions from urology trainees and consultants regarding the need for, and structure of, a post-specialty training Urology Simulation Boot Camp (USBC) for consultant practice.

METHODS AND RESULTS

A survey-based study was conducted, and 'Google Forms' were distributed electronically via social media. Urology specialist trainees (ST) in years 5-7 (ST5-ST7), post-certification of completion of training (CCT) fellows and ST3 boot camp faculty consultants in practice for ≤5 years and >5 years were included. One hundred and seven responses were received. 97.2% of responders thought a pre-consultant USBC was worthwhile; 55.1% selected the course duration to be 2 days. 47.7% felt that the USBC should be delivered post-exam in ST7. 91.6%, 43.9%, 73.8%, 87.9% and 74.8% considered that modules in emergency operative procedures, novel uro-technologies, delivering multidisciplinary team (MDT) meetings, non-clinical consultant roles and responsibilities, stress and burnout to be important, respectively. 62.6% and 31.8% felt that the course should be wholly or part-funded by Health Education England (HEE).

CONCLUSIONS

A post-specialty training, pre-consultant, USBC delivered post-exam in ST7, is worthwhile and should include modules on emergency operative procedures, leading MDTs, non-clinical roles and responsibilities and managing stress and burnout in consultant careers. Ideally, it should be fully/part-funded by HEE.

The Impact of Surgical Boot Camp on Medical Student Confidence and Imposter Syndrome

INTRODUCTION

Transitioning from medical student to surgical intern is accompanied by increased responsibility, stress, and clinical burden. This environment lends itself to imposter syndrome (IS), a psychological condition grounded in self-doubt causing fear of being discovered as fraud despite adequate abilities. We hypothesized a 2-week surgical boot camp for fourth year medical students would improve confidence in technical skills/knowledge and IS.

METHODS

Thirty medical students matching into surgical specialties completed the boot-camp in February 2020. Presurveys/postsurveys assessed confidence levels using a 1-5 Likert scale regarding 32 technical skills and knowledge points. The Clance Impostor Phenomenon Scale (CIPS) assessed IS, where increasing scores correlate to greater IS.

RESULTS

Median (interquartile range [IQR]) subject age was 27 y (26, 28), 20 (66.7%) were male, and 21 (70%) were Caucasian. Of the 30 students, 23 (76.7%) had a break in training with a median [IQR] of 2 [1, 3] y outside of medicine. Confidence scores were significantly improved in all five assessment categories (P < 0.05); however, there was no change in CIPS in median [IQR] presurveys versus postsurveys (65.5 [52, 75] versus 64 [52, 75], P = 0.70). Females had higher mean (standard deviation) pre-CIPS than males (68.4 [15.2] versus 61.6 [14.9], P = 0.02). There was no strong correlation between age and CIPS in the presurvey (Spearman Rank Correlation Coefficient [SRCC]: 0.29, P = 0.19) or postsurvey (SRCC: 0.31, P = 0.10). While subjects who worked outside of medicine had a stronger relationship with IS (SRCC: 0.37, P = 0.05), multivariable regression analysis did not reveal any significant differences.

CONCLUSIONS

We advocate for surgical boot-camp training courses to improve trainee skill and confidence. As IS is not improved by boot camp, additional research is needed to identify opportunities to improve IS among surgical trainees.

Specialty-Specific Entrustable Professional Activities: A Bridge to Internship

Background Undergraduate medical education aims to prepare learners to become capable residents. New interns are expected to perform clinical tasks with distant supervision reliant on having acquired a medical degree. However, there is limited data to discuss what entrustment residency programs grant versus what the medical schools believe they have trained their graduates to perform. At our institution, we sought to foster an alliance between undergraduate medical education (UME) and graduate medical education (GME) toward specialty-specific entrustable professional activities (SSEPAs). These SSEPAs create a bridge to residency and help students structure the final year of medical school while striving for entrustability for day one of residency. This paper describes the SSEPA curriculum development process and student self-assessment of competence. Methodology We piloted an SSEPA program with the departments of Family Medicine, Internal Medicine, Neurology, and Obstetrics & Gynecology. Utilizing Kern's curriculum development framework, each specialty designed a longitudinal curriculum with a post-match capstone course. Students participated in pre-course and post-course self-assessments utilizing the Chen scale for each entrustable professional activity (EPA). Results A total of 42 students successfully completed the SSEPA curriculum in these four specialties. Students' self-assessed competence levels rose from 2.61 to 3.65 in Internal Medicine; 3.23 to 4.12 in Obstetrics and Gynecology; 3.62 to 4.13 in Neurology; and 3.65 to 3.79 in Family Medicine. Students across all specialties noted an increase in confidence from 3.45 to 4.38 in Internal Medicine; 3.3 to 4.6 in Obstetrics and Gynecology; 3.25 to 4.25 in Neurology; and 4.33 to 4.67 in Family Medicine. Conclusions A specialty-specific curriculum utilizing a competency-based framework for learners traversing the UME to GME journey in the final year of medical school improves learner confidence in their clinical abilities and may lead to an improved educational handoff between UME and GME.

The First Two Years of the Association of Pediatric Surgery Training Program Directors (APSTPD) Transition to Fellowship Course: Lessons Learned and Future Directions

OBJECTIVE

The first transition to fellowship course for incoming pediatric surgery fellows was held in the US in 2018 and the second in 2019. The course aimed to facilitate a successful transition in to fellowship by introduction of the professional, patient care, and technical aspects unique to pediatric surgery training. The purpose of this study was to evaluate the feasibility and effectiveness of the first two years of this course in the US and discuss subsequent evolution of this endeavor.

DESIGN

This is a descriptive and qualitative analysis of two years' experience with the Association of Pediatric Surgery Training Program Directors' (APSTPD) Transition to Fellowship course. Course development and curriculum, including clinical knowledge, soft skills, and hands-on skills labs, are presented. Participating incoming fellows completed multiple choice, boards-style pre- and post-tests. Scores were compared to determine if knowledge was effectively transferred. Participants also completed post-course evaluations and subsequent 3- or 12-month surveys inquiring on the lasting impact of the course on their transition into fellowship. Standard univariate statistics were used to present results.

SETTING

The first APSTPD Transition to Fellowship course was held at the Johns Hopkins Hospital in Baltimore, Maryland in 2018, and the second course was held at the Oregon Health and Science University in Portland, Oregon in 2019.

PARTICIPANTS

All fellows entering ACGME-certified Pediatric Surgery fellowships in the United States were invited to participate. Twenty fellows accepted and attended in 2018, and fourteen fellows participated in 2019.

RESULTS

There were 34 incoming pediatric surgery fellow participants over 2 years. Faculty represented more than 10 institutions each year. Pre- and post-test scores were similar between years, with a significant improvement of scores after completion of the course (67±10% vs 79±8%, p < 0.001). Feedback from participants was overwhelmingly positive, with skills labs being attendees' favorite component. When asked about usefulness of individual course sessions, more attendees found clinical sessions more useful than soft skills (93% vs 73%, p = 0.011). Almost all (90%) of participants reported the course met its stated purpose and would recommend the course to future fellows. This was further reflected on 3 and 12 month follow up surveys wherein 85% stated they found the course helpful during the first few months of fellowship and 90% would still recommend it.

CONCLUSIONS

A transition to fellowship course in the US for incoming pediatric surgery fellows is logistically feasible, effective in transfer of knowledge, and highly regarded among attendees. Feedback from each course has been used to improve the subsequent courses, ensuring that it remains a valuable addition to pediatric surgical training in the US.

Effects of an Experiential Trauma Bootcamp on PGY 3 Anesthesiology Residents' Knowledge and Confidence Levels

BACKGROUND

Bootcamp-style education involves short, intense educational sessions and is a proven educational modality in anesthesia medical education. However, rarely has it been used with senior anesthesiology residents and never in exposing these residents to a curriculum aimed at care of the trauma patient. The purpose of this study was to design and implement an experiential bootcamp to prepare anesthesiology residents to take senior trauma call at a Level 1 trauma center in the Southeastern United States.

METHODS

Before taking senior trauma call, 21 postgraduate year 3 anesthesiology residents took part in an 8-hour trauma bootcamp that combined flipped classroom-style education with immersive, procedural, and augmented reality simulation facilitated by subject matter experts. Before and after the bootcamp, residents completed 17-item confidence and 20-item knowledge questionnaires developed by the study authors. Results were compared before and after the bootcamp to determine overall change in confidence and knowledge levels pertaining to caring for trauma patients and taking senior trauma call. Additionally, residents completed an evaluation measuring their perceptions of the benefit of the educational offering.

RESULTS

Statistically significant increases were seen in 16 out of 17 confidence questions (P < .001) and 12 out of 20 knowledge questions (P < .001). Additionally, respondents indicated that they found the content to be valuable and likely to improve their care delivery within the clinical setting.

CONCLUSIONS

Following this bootcamp, postcourse surveys demonstrated that residents' knowledge and confidence increased significantly through simulation combined with a flipped-classroom approach in preparation for senior trauma call.

Evaluation of an Internal Medicine Transition to Residency Course

OBJECTIVES

We sought to evaluate the effectiveness of a novel Internal Medicine (IM) transition to residency (TTR) curriculum.

METHODS

We performed a paired pre-/postsurvey evaluation of graduating fourth-year medical students' perceived preparedness and medical knowledge after participating in a recently developed IM TTR course.

RESULTS

The response rate was 51% (24 of 47). There was a significant improvement in 15 of 17 perceived preparedness items and significant improvement in the medical students' performance on the 8-question medical knowledge test.

CONCLUSIONS

The IM TTR curriculum improved medical students' medical knowledge and perceived preparedness for internship on a variety of high-yield clinical topics. The curriculum may be appealing to other institutions that are developing or revamping TTR courses.

Clinical Skills Day: A Novel Approach to Enhancing Procedural Skills Teaching for Foundation Year One Doctors

Background Completion of the Foundation Year One (FY1) doctor training is a requirement for full General Medical Council registration in the United Kingdom. Training during this year is mapped to a curriculum with one of the key elements being safe procedural skills. The objective of this project was to improve the teaching of procedural skills through the means of a Clinical Skills Day (CSD) and to quantify any improvement. Materials and methods A one-group pretest-posttest design was conducted on 32 doctors who completed a confidence inventory before and after four core procedural stations: suturing, urethral catheterisation (both male and female), lumbar puncture, and bimanual and speculum examinations. The intervention of simulated procedural skills occurred under the supervision of senior clinicians, with FY1 doctors receiving teaching and practising the four skills. The primary outcome was the impact of a CSD on trainees' confidence in performing certain skills. Pre- and post-CSD trainees' confidence levels were collected via an online-focused questionnaire and descriptive statistics, paired t-test, and one-way analysis of variance (ANOVA) with post-hoc Bonferroni comparisons were undertaken for statistical analysis. Results The difference in the mean scores of confidence post-intervention was significant in all four procedural stations with or without supervision (p <0.0001). Conclusions The use of CSDs impacted positively on the FY1 doctors' confidence in performing certain skills. Wider implementation of this promising approach for Foundation Doctors is recommended.

How Prepared Are They? Pediatric Boot Camps and Intern Performance

OBJECTIVE

To determine whether participation in a pediatric boot camp during medical school was associated with higher intern performance. Secondary objectives were to determine whether participation in general boot camps, pediatric subinternships or pediatric electives was associated with higher performance.

METHODS

Intern surveys and faculty performance assessments during early internship were collected from a convenience sample of pediatric residency programs. Interns completed a survey regarding participation in medical school boot camps, pediatric subinternships and pediatric electives. Faculty assessed intern performance on selected Milestone-based subcompetencies on a 5-point scale following each intern's initial inpatient rotation and results were compared between groups.

RESULTS

Seventeen pediatric residency programs participated. Two hundred eighty-seven interns completed the survey (69%), and faculty completed assessments on 71% of these interns. Of interns with complete faculty assessments (n = 198), 25% participated in 5 or more days of pediatric boot camp, 30% in general boot camp, and 45% in no boot camp. There were no educationally significant associations between participation in 5 or more days of pediatric boot camp, general boot camp, subinternships, or electives and intern performance. Interns completing at least 10 days of pediatric boot camp (n = 25) had slightly higher ratings for incorporating feedback and engaging in help-seeking behavior during June and July only.

CONCLUSIONS

Participation in pediatric boot camps, general boot camps, pediatric subinternships or electives was not associated with substantially higher intern performance as measured by selected Milestone subcompetencies. Pediatric educators should carefully consider boot camp curricula and anticipated outcomes associated with boot camp participation.

The Hidden Impact of Neonatology Boot Camp: A Qualitative Study

INTRODUCTION

Simulation-based boot camps have been evaluated by fellows as an effective way to learn, to improve self-confidence, and to prepare for new responsibilities. However, existing studies do not explore how boot camps may contribute to other critical aspects of trainee development. Our objective was to use qualitative research methodology to characterize trainees' experiences of boot camp and its impact on their professional development.

METHODS

This study used a phenomenological framework to explore fellows' experience of boot camp. Semistructured phone interviews were conducted with first-year neonatology fellows after attending the Regional Neonatology Boot Camp. Interviews were transcribed and coded for themes. The authors continually evaluated the coding categories in an iterative process until consensus was reached.

RESULTS

Seventy-seven first-year neonatal-perinatal medicine fellows representing 16 fellowship programs participated in the Regional Neonatology Boot Camp in 2016 and 2017. Fifteen fellows from 10 institutions were interviewed before reaching thematic saturation. Five themes were identified: introspection about starting fellowship, learning to lead and communicate, gaining reassurance from the shared experience, understanding the fellow role, and developing future identity as a neonatologist.

CONCLUSIONS

Participation in boot camp enhances fellows' professional identity formation (PIF) by incorporating key aspects of socialization, including role models and mentors, a variety of experiential learning, and opportunities for conscious self-reflection. In designing future boot camp experiences, educators should integrate these elements into the curriculum to support PIF and explicitly state PIF as a learning objective.

The use of a surgical boot camp combining anatomical education and surgical simulation for internship preparedness among senior medical students

BACKGROUND

Senior medical students feel unprepared for surgical procedures and care for surgery patients when they begin their internship. This study sought to introduce and evaluate a surgical boot camp training for senior medical students.

METHODS

A 44-h surgical boot camp program of lectures on clinical practice simulation, anatomical dissections, and simulated operation on cadavers was designed, implemented, and evaluated during the 2018 to 2019 academic year. A self-administered questionnaire was used to assess students' perceptions of the content, delivery, and self-confidence. The mini-Clinical Evaluation Exercise (mini-CEX) and the Operative Performance Rating System were used to assess skills essential to good clinical care and to facilitate feedback.

RESULTS

Over 93% of the students were satisfied with the surgical boot camp, training equipment, and learning materials provided. After six sessions of training, 85.3% reported gaining self-confidence and performed better in some surgical procedures such as major gastrectomy. The mini-CEX scores suggested significant improvement in the students' clinical skills, attitudes, and behaviors (P < 0.01). Ninety-eight percent of students felt that the anatomical knowledge taught met their needs. The scores of the Operative Performance Rating System suggested that the students' surgical skills such as instruments handling, incising, treatment of surrounding tissues (blood vessels, nerves), and smoothness of the whole operation had increased significantly following the surgical boot camp (All P < 0.01).

CONCLUSION

The surgical boot camp curriculum improved students' satisfaction and confidence in core clinical practice competencies. Therefore, medical schools the world over should continue to seek ways to bridge the gaps between pre-clinical, clinical, and internship training.

Can We Identify Predictors of Success in Contouring Education for Radiation Oncology Trainees? An Analysis of the Anatomy and Radiology Contouring Bootcamp: Predictors of Success in Contouring Education

INTRODUCTION

Although several different contouring instructional programs are available to radiation oncologists and trainees, very little is known about which methods and resources benefit learners most, and whether some learners may need alternate forms of instruction. This study aimed to determine the factors that were predictors of learners' success in anatomy, radiology, and contouring education.

METHODS

Participants in the online and face-to-face (F2F) Anatomy and Radiology Contouring (ARC) Bootcamp completed pre- and post-intervention evaluations that assessed anatomy/radiology knowledge, contouring skills, self-confidence, and spatial ability. Baseline factors were assessed as predictors of outcomes across multiple educational domains.

RESULTS

One hundred and eighty (F2F: n=40; online: n=140) participants enrolled in the ARC Bootcamp and fifty-seven (F2F: n=30; online: n=27) participants completed both evaluations. Of the participants enrolled, 37% were female, and most were radiation oncology (RO) residents (62%). In the anatomy/radiology knowledge testing, all quartiles (based on baseline performance) improved numerically, however, the largest improvements occurred in learners with the lowest baseline scores (p<0.001). At the end of the Bootcamp, learners with lower-performing scores did not reach the level of learners with the highest baseline scores (Bonferroni-corrected p<0.001). Regarding the contouring assessment, improvements were only evident for the participants with lower-performing baseline scores (p<0.05). Spatial anatomy skills, as measured by the spatial anatomy task, was correlated to contouring ability. Overall, the greatest improvements were seen for learners in postgraduate year 1-3, those with no previous rotation experience in a given discipline, and those who attended from 'other' programs (i.e. medical physics residents and medical students).

CONCLUSIONS

The ARC Bootcamp improved all levels of performers' anatomy and radiology knowledge but only lower-performers' contouring ability. The course alone does not help lower-performing learners reach the abilities of higher-performers. The ARC Bootcamp tends to be most beneficial for participants with less RO experience. Curriculum modifications can be made to help support ARC Bootcamp participants with lower performing scores.

The Otolaryngology boot camp: a scoping review evaluating commonalities and appraisal for curriculum design and delivery

OBJECTIVE

Surgical boot camps are becoming increasingly popular in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Despite pioneering virtual reality and simulation-based surgical education, these boot camps have lacked critical appraisal. The objective of this article was to examine the adoption and utility of surgical boot camps in OHNS residency training programs around the world.

DATA SOURCES

Ovid Medline and PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. Additionally, a grey literature search was performed.

REVIEW METHODS

Inclusion criteria were peer-reviewed publications and grey literature sources that reported on OHNS boot camps for the novice learner. The search was restricted to human studies published in English. Studies were excluded if they were not examining junior trainees.

RESULTS

A total of 551 articles were identified. Following removal of duplicates, screening, and full text review, 16 articles were included for analysis. Seven major boot camps were identified across various academic sites in the world. Most boot camps were one-day intensive camps incorporating a mixture of didactic, skill specific, and simulation sessions using an array of task trainers and high-fidelity simulators focusing on OHNS emergencies. Studies measuring trainee outcomes demonstrated improvement in trainee confidence, immediate knowledge, and skill acquisition.

CONCLUSION

Surgical boot camps appear to be an effective tool for short term knowledge and skill acquisition. Further studies should examine retention of skill and maintenance of confidence over longer intervals, as little is known about these lasting effects.

Hopes and fears: A qualitative analysis of the intern perspective at the start of EM residency

Objectives

Most emergency medicine (EM) residency programs have orientation curricula to guide interns through the transition from medical school to residency, although no standard components are required. This transition is recognized as a challenging time for young physician learners; however, there is no current understanding of the perspective of incoming interns as they enter residency. We sought to identify themes, examine the current literature, and reflect on the experiences of our residency leadership to inform the creation of orientation activities that foster positive experiences, as well as directly address intern fears and anxieties.

Methods

This qualitative study collected free text responses on the first day of EM orientation regarding areas of high excitement and high fear as interns entered residency. Data were collected from 2011 to 2019 in a 4-year EM residency program and a 6-year combined EM-Anesthesia residency program in the Mid-Atlantic. An inductive approach was used to code intern responses and develop themes within each category, and a frequency analysis was performed.

Results

A total of 112 interns participated. Thematic analysis of coded responses yielded 11 themes around "most excited" and 13 themes around "most scared." The most frequent themes for "most excited" were: (1) Forming new relationships, (2) Building and applying knowledge, and (3) Being responsible for the care and education of others. For "most scared," the most frequent themes were: (1) work-life balance and burnout, (2) making harmful mistakes, and (3) knowledge wealth and retention.

Conclusions

We identified themes of high excitement and high fear for interns entering residency orientation. Based on the themes developed and current literature, recommendations for residency programs regarding intern orientation are provided, specifically that programs intentionally address opportunities for professional identity formation, building relationships with new people/places, emphasizing wellness, and mitigating burnout.

Comparison of multimodal active learning and single-modality procedural simulation for central venous catheter insertion for incoming residents in anesthesiology: a prospective and randomized study

BACKGROUND

Active learning methods, including low-fidelity simulation, are useful but the incremental learning effect of each method is however limited. We designed this study to assess if combining flipped classroom and the modified Peyton's « 4-steps» method during procedural simulation (intervention group [IG]) would provide better learning results than simulation alone (control group [CG]) in the context of central venous catheter insertion training.

METHODS

This prospective, single-center, and randomized study took place in 2017 in a single simulation center. All first year Anesthesiology residents of Ile de France area at the start of their residency were randomly included either in the IG or CG during a seminar aimed at providing initial procedural skills with low-fidelity simulation. A composite learning score which included knowledge MCQ and a questionnaire assessing satisfaction and value of the training session was recorded after training (primary outcome, /100). A randomized sub-group of learners of each group were video-recorded during central venous catheter insertion at the end of training and their skills were evaluated with validated tools, including a specific checklist and a global rating scale (GRS).

RESULTS

Among 89 anesthesiology residents, 48 and 41 learners were randomized in the intervention and control groups respectively. Of the IG residents, 40/48 (83%) had read the learning material prior to the session. There was no significant difference regarding the composite outcome ([IG]= 81.1 vs [CG] = 80.5 /100 (p = 0.68)). Results of the post-session MCQ knowledge questionnaire were also non-significantly different. Residents were similarly satisfied and described a significant improvement of their knowledge and skills after training. Learners highly valued the training session as a mean to improve their future practice. No significant differences regarding checklist and GRS scores were observed.

CONCLUSIONS

A multimodal active learning strategy of procedural learning did not provide better learning outcomes when compared to a traditional simulation method. In both groups, satisfaction was high and perception of the acquired theoretical and practical knowledge was improved after training.

Qualitative Analysis of a Virtual Near-Peer Pediatric Boot Camp Elective

OBJECTIVE

To explore fourth-year medical students' experience with a virtual, near-peer facilitated pediatric boot camp through the lens of self-determination theory (SDT).

METHODS

We developed a virtual pediatric boot camp elective for fourth-year medical students pursuing pediatric residency using Kern's six steps of curriculum development. The two-week virtual elective consisted of facilitated video conferences and small group discussions led by two senior pediatric residents. Semi-structured focus groups were conducted after elective completion. Using SDT as our conceptual framework, we explored participants' experience with the near-peer facilitation of the boot camp. Focus group recordings were transcribed and thematically analyzed using deductive coding for SDT, with inductive coding for themes outside the theory's scope. Saturation was reached after three focus groups. The codebook was iteratively revised through peer debriefing between coders and reviewed by other authors. Credibility was established through member checking.

RESULTS

Ninety-two percent of eligible medical students (n = 23/25) participated in the boot camp with attendance ranging from 18-21 students per session. Twelve students (52%) participated in three focus groups. Qualitative analysis identified five major themes. Four themes consistent with SDT emerged: competence, autonomy, relatedness to near-peers, and relatedness to specialty/institution. The learning environment, including the virtual setting, emerged as an additional, non-SDT-related theme.

CONCLUSIONS

Medical students' experience with our virtual boot camp closely aligned with SDT. Near-peer relatedness emerged as a unique theme which could be further investigated in other aspects of medical student education. Future research could evaluate higher-level learning outcomes from near-peer educational opportunities.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01466-w.

Postgraduate medical procedural skills: attainment of curricular competencies using enhanced simulation-based mastery learning at a novel national boot camp

INTRODUCTION

A new UK medical postgraduate curriculum prompted the creation of a novel national medical postgraduate 'boot camp'. An enhanced simulation-based mastery learning (SBML) methodology was created to deliver procedural skills teaching within this national boot camp. This study aimed to explore the impact of SBML in a UK medical boot camp.

METHODS

One-hundred and two Scottish medical trainees attended a 3-day boot camp starting in August 2019. The novel enhanced SBML pathway entailed online pre-learning resources, deliberate practice, and simulation assessment and feedback. Data were gathered via pre- and post-boot camp questionnaires and assessment checklists.

RESULTS

The vast majority of learners achieved the required standard of performance. Learners reported increased skill confidence levels, including skills not performed at the boot camp.

CONCLUSION

An enhanced SBML methodology in a boot camp model enabled streamlined, standardised procedural skill teaching to a national cohort of junior doctors. Training curricular competencies were achieved alongside increased skill confidence.

A Mixed-Methods Realist Analysis of an Interdisciplinary Simulation Intervention for Psychiatry Residents

OBJECTIVES

Simulation research in postgraduate psychiatry remains limited, with minimal studies on interdisciplinary involvement and mechanisms of change. To address these gaps, the authors implemented a mixed-methods realist analysis of an interdisciplinary simulation intervention administered to psychiatry residents.

METHODS

The University of Calgary implemented a simulation intervention for psychiatry residents. Eight junior residents participated in or observed 4 scenarios and eighteen senior residents participated in or observed 8 scenarios. Scenarios lasted 15 minutes with a pre-simulation orientation and post-scenario debrief. Most scenarios involved interdisciplinary staff. Scenarios included agitated and suicidal patients; treatment-related emergencies; and challenging conversations. All residents completed pre- and post-simulation surveys reporting confidence levels. Changes in confidence were analyzed using paired t tests and differences between junior and senior residents' confidence using ANOVA. Eleven residents participated in 2 focus groups. Transcripts were analyzed using a constant comparative model to identify contexts, mechanisms, outcomes, and the relationship between these realist categories. Key themes were extracted using generic theme analysis.

RESULTS

Aggregated survey data demonstrated statistically significant improvements in self-reported confidence for 7 of 8 proposed scenarios, with variations in confidence outcomes between junior and senior residents. Four themes emerged: (1) How Simulations Facilitate Learning, (2) The Role of Pre-simulation Instructions, (3) Factors Facilitating Confidence, (4) Positive Effects of Interdisciplinary Involvement.

CONCLUSIONS

This study identifies possible mechanisms for residents' self-reported improvements in learning and confidence, which may help programs tailor interventions. Furthermore, this study suggests there may be benefits to interdisciplinary simulations, with self-reported outcomes of improved collaboration and safety planning.

Perception Precedes Reality: A Simulation and Procedural Bootcamp Improves Residents’ Comfort With Transitioning to Clinical Anesthesiology Training

Background

The transition from internship to clinical anesthesiology (CA) training is often difficult given the differences in workflow, procedures, environment, and clinical situations. The primary aims of this study were to determine if a standardized introductory bootcamp could improve clinical knowledge and self-perceived comfort level of new anesthesiology residents in performing common operating room procedures and management of common intraoperative problems. The secondary aim of the study was to see if a standardized bootcamp could be replicated at other programs.

Methods

The introduction to anesthesiology resident bootcamp was developed at one institution in 2015 then expanded to a second program in 2019. The bootcamp was a one-day experience consisting of simulation and task trainers that all rising first-year CA residents (CA-1) participated in during their first month of anesthesiology training. All participating residents were given a survey immediately before and after the bootcamp. The average ratings of the questions were calculated and used as the primary measure. The Anesthesia Knowledge Test (AKT) was used as a surrogate measure of participant knowledge.

Results

From 2015 to 2020, a total of 105 residents completed the pre-survey and 109 completed the post-survey across the two sites. The improvement in average rating was significant (Pre: 2.04±0.46 versus Post: 3.09±0.52 p<0.0001). Individual item analysis also showed significant improvement on all of the eight items (p<0.0001). Analyses by site revealed the same results at both average score and item level. There was no significant cohort difference in either AKT-0 (Control: 57.84±26.86 versus Intervention 50.13±25.14, p=0.14) or AKT-1 (Control: 41.06±26.42 versus Intervention 41.70±26.60, p=0.90) percentile scores.

Conclusions

Incorporation of an introduction to anesthesia bootcamp for new residents significantly improves participant comfort level and is reproducible across institutions. However, it does not improve resident performance on standardized tests.

UME-to-GME PandEMonium in COVID-19: Large-Scale Implementation of a Virtual ACGME Milestone-Based Curriculum for Senior Medical Students Matched Into Emergency Medicine

BACKGROUND

The COVID-19 pandemic displaced newly matched emergency medicine "pre-interns" from in-person educational experiences at the end of medical school. This called for novel remote teaching modalities.

OBJECTIVE

This study assesses effectiveness of a multisite Accreditation Council for Graduate Medical Education (ACGME) sub-competency-based curricular implementation on Slack during the first wave of the COVID-19 pandemic in the United States.

METHODS

Emergency medicine residency programs were recruited via national organization listservs. Programs designated instructors to manage communications and teaching for the senior medical students who had matched to their programs (pre-interns) in spring/summer 2020. Pre- and post-surveys of trainees and instructors assessed perceived preparedness for residency, perceived effectiveness of common virtual educational modalities, and concern for the pandemic's effects on medical education utilizing a Likert scale of 1 (very unconcerned) to 5 (very concerned). Data were analyzed using descriptive statistics and the t test.

RESULTS

Of 276 possible residency programs, 28 enrolled. Of 324 possible pre-interns, 297 (91.7%) completed pre-surveys in April/May and 249 (76.9%) completed post-surveys in June/July. The median weeks since performing a physical examination was 8 (IQR 7-12), since attending in-person didactics was 10 (IQR 8-15) and of rotation displacement was 4 (IQR 2-6). Perceived preparedness increased both overall and for 14 of 21 ACGME Milestone topics taught. Instructors reported higher mean concern (4.32, 95% CI 4.23-4.41) than pre-interns (2.88, 95% CI 2.74-3.02) regarding the pandemic's negative effects on medical education.

CONCLUSIONS

Pre-interns reported improvements in residency preparedness after participating in this ACGME sub-competency-based curriculum on Slack.

A systematic review of methodological principles and delivery of surgical simulation bootcamps

BACKGROUND

The growth of "bootcamp style" simulation training in surgical practice has been exponential over the last decade. Developing and delivering a surgical bootcamp requires a significant investment. This systematic review aims to identify the key components that allow for a successful and rewarding surgical bootcamp course to be implemented that can be applied to all surgical specialities.

METHODS

To understand the surgical bootcamp principles and delivery mechanisms, we searched peer-reviewed, English language studies published between 2000 and 21.

RESULTS

From 137 articles, 14 studies with a Medical Education Research Quality Instrument Score of >11.5 were included. Most studies followed the core components; delivery at transition (12), mapping syllabus (13), multimodality delivery (14), and deliberate practice with formative feedback (12) apart from 1:1 training by only 2 studies.

CONCLUSIONS

Our review suggests that Surgical bootcamp can be an extremely useful education tool for trainees if 5 pillars of a boot camp are respected.

The Effectiveness of a Pediatric Emergency Medicine Block Education Session for Pediatric Residents

BACKGROUND AND OBJECTIVE

There exists no standardized curriculum for pediatric residents to develop procedural skills during residency training. Many pediatric residency programs are transitioning to block education sessions; the effectiveness of this format for delivering pediatric emergency medicine (PEM) procedural curriculum has not been evaluated. The objective is to determine if a PEM block education session improved pediatric residents' knowledge and confidence in 4 domains: laceration repair, splinting of extremities, resuscitation/airway management, and point-of-care ultrasound.

METHODS

Pediatric residents at the University of California at San Diego participated in a 4-hour PEM block education session during which they rotated through 4 interactive stations: laceration repair, splinting of extremities, resuscitation/airway management, and point-of-care ultrasound. Residents' knowledge was assessed using 2 distinct multiple-choice tests, each consisting of 20 questions (5 questions per domain). Residents were block randomized to take one version of the test as the pretest and the other version as the posttest. Residents' confidence was assessed for each domain using a standardized 5-point confidence tool before and after the block education session.

RESULTS

Forty-five residents attended the PEM block education session. Forty-three residents completed both the preknowledge and postknowledge tests. The PEM block education session resulted in an almost 14% increase in knowledge test when comparing preknowledge and postknowledge scores (P < 0.0001). Significant improvement in resident confidence was seen in all 4 domains (P < 0.0001).

CONCLUSIONS

The PEM block educational session improved both pediatric residents' knowledge and confidence in domains frequently encountered in the pediatric emergency department.

Impact of an end-of-fourth-year emergency medicine bootcamp

Background

The final months of the fourth-year of medical school are variable in educational and clinical experience, and the effect on clinical knowledge and preparedness for residency is unclear. Specialty-specific “bootcamps” are a growing trend in medical education aimed at increasing clinical knowledge, procedural skills, and confidence prior to the start of residency.

Methods

We developed a 4-week Emergency Medicine (EM) bootcamp offered during the final month of medical school. At the conclusion of the course, participants evaluated its impact. EM residency-matched participants and non-participants were asked to self-evaluate their clinical knowledge, procedural skills and confidence 1 month into the start of residency. Program directors were surveyed to assess participants and non-participants across the same domains. A Fisher’s exact test was performed to test whether responses between participants and non-participants were statistically different.

Results

From 2015 to 2018, 22 students participated in the bootcamp. The majority reported improved confidence, competence, and procedural skills upon completion of the course. Self-assessed confidence was significantly higher in EM-matched participants 1 month into residency compared to EM-matched non-participants (p = 0.009). Self-assessed clinical knowledge and procedural skill competency was higher in participants than non-participants but did not reach statistical significance. Program directors rated EM-matched participants higher in all domains but this difference was also not statistically significant.

Conclusions

Participation in an EM bootcamp increases self-confidence at the start of residency among EM-matched residents. EM bootcamps and other specialty-specific courses at the end of medical school may ease the transition from student to clinician and may improve clinical knowledge and procedural skills.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12245-021-00371-8.

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.

Describing Overarching Curricular Goals for Individualized Education

Phenomenon: The phenomenon of individualized education, an essential component of competency-based medical education, addresses individual learner needs while working toward standardized learning outcomes. One challenge with broadly implementing individualized education is the lack of a pragmatic operational definition. To formalize expectations for individualized education, the Accreditation Council of Graduate Medical Education in 2013 began requiring six months of individualized curriculum (IC) during pediatric residency; however, there is not a national standard of formal curricular goals for the IC as an educational entity. Examining and describing the overarching curricular goals of IC could provide a framework for discourse about and further study of individualized education in medicine across disciplines and the continuum of medical education. Thus, we aimed to describe the phenomenon of individualized education through the lens of the goals of the IC in pediatric residency in the United States. Approach: In 2017, a purposeful sample of Pediatric Residency leaders were recruited to represent a diverse sample of program sizes, regions of the country, and importance of the IC to the program leadership. They completed an online survey with open-ended questions describing formal and implicit goals of their program's IC. The authors analyzed responses initially using conventional content analysis, then investigated whether the themes for program goals aligned with any existing educational theory. The concepts and language aligned with the principles of self-determination theory (SDT); therefore, the IC goals were subsequently grouped using the SDT domains of relatedness, autonomy, and competence. A focus group with a subset of survey respondents was conducted for member checking and elaboration of concepts. Findings: Program leaders from a diverse sample of 36 programs participated in the survey and a subset of 11 programs participated in the focus group. The common goals across all programs are listed in parentheses and organized by domains of SDT: 1)Relatedness goals (engage in mentorship, select a career) cultivate resident's professional identity based on their desired future career path; 2)autonomy goals (create a learning plan, practice accountability) help residents plan their path; and fulfillment of their plans lead to 3)competence goals (develop targeted clinical skills and knowledge, ensure comprehensive exposure, address learning gaps), ensuring they have a comprehensive skill set for their chosen identity. Insights: This study provides a framework to describe the phenomenon of individualized education through the lens of IC curricular goals in pediatric residency. The goals for IC that emerged from this study serve as a pragmatic framework for implementation of individualized education. They provide a common language and structure to promote more rigorous and collaborative study of individualized education across programs, disciplines, and settings in medicine. They may function as a roadmap for learners to navigate educational activities and for programs to help shape the experiences of their learners and examine outcomes of individualized education in their programs. The framework can also help individual pediatric residency programs structure improvements to their IC. Disciplines beyond pediatrics may also use this framework to better structure elective experiences to capitalize on the benefits of individual education.

Oncology boot camp: A preparatory curriculum for advanced pharmacy practice experience students

INTRODUCTION

The primary objective of this study was to evaluate the effectiveness of an autonomous oncology boot camp on Advanced Pharmacy Practice Experience (APPE) student knowledge. Secondary objectives included assessing student perception of the virtual learning experience and overall comfort level with the material.

METHODS

APPE students rotating through our institution between November 2019 and March 2020 were voluntarily enrolled in a 4-hour oncology-focused boot camp, which included five PlayPosit (Denver, CO, USA) interactive video lectures embedded with case-based application questions followed by one comprehensive web-based Quandary (Victoria, BC, Canada) action-maze case. Student learning was measured by a pre- and post-intervention exam. A web survey tool (Qualtrics, Provo, UT, USA) collected student perceptions evaluating their comfort with oncology-specific drug knowledge and APPE rotations tasks.

RESULTS

Fifty students enrolled in the oncology boot camp, with 100% completing the pre- and post-intervention assessments. Overall, pre-intervention exam scores (mean: 55.4%, SD: 21.8%) improved by 23.2% following the boot camp (mean: 78.6%, SD: 19.2%; p < 0.001). Students performed better on all 10 exam questions, with 6 questions showing a statistically significant improvement (p < 0.05). Forty-five students (90%) completed the perception surveys. Of those, 93% agreed that it effectively reinforced important oncology knowledge, 91% supported the autonomous design, and 82% would recommend the oncology boot camp for future students.

CONCLUSION

The boot camp proved to be a beneficial educational tool that enhanced student knowledge and confidence in navigating common oncology concepts. Students valued the ability to independently complete the activities and supported its continuation.

Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

Simulation training has taken a prominent role in otolaryngology-head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

Internship orientation: An essential facilitatory bridging step for medical students

Background

Internship is a facilitatory period that hones skills and helps in the evolution of a qualified medical student to a competent doctor. The feeling of a final year student joining as a fresh intern after successfully completing the final professional examination will be directionless without a bridging initiative through a buffer program. Fresh interns need to be oriented to the fundamentals of working effectively with a patient as a whole and not as a separate discipline. This study was done to evaluate the effectiveness of the internship orientation program and to assess the feedback of participants about this program.

Methodology

This was a study conducted on 235 freshly joined medical interns. The process included evaluation of a well-structured seven-day orientation program by prevalidated structured Multiple Choice Questions (MCQs) and feedback.

Results

All interns performed satisfactorily in the post-test with a mean score of 74.13 ± 7.18. Post-test scores were highest for procedure skills and communication skills, including medical ethics. Overall, 232 (99%) of interns responded that the program was useful and it successfully enhanced their clinical skills; 221 (94%) of interns expressed that the content of the program was excellent to good; and 228 (97%) of interns felt that the method used for training was appropriate. Interns also documented that there were a few new skills that were acquired by attending this program.

Conclusion

There is an unmet need for an internship orientation program across all medical colleges to lay a strong foundation for naive interns. Based on the results, we recommend an internship orientation program for a smooth and swift transition from that of a medical student to professional life. It will orient the interns and lay the foundation for the next level of assignment in building their professional career.

Supporting the transition to becoming a medical registrar

Introduction

Physician training is seeing increasing numbers of doctors adopting the role of medical registrar. Non-clinical as well as clinical responsibilities are a source of great anxiety prior to trainees assuming this role.

Methods

A standardised, blended, 1-day course to address the needs of doctors transitioning to become a medical registrar was designed and delivered across four hospitals. A mixed methods evaluation approach was employed to assess the effect of the course.

Results

Thirty-four trainees approaching the transition to becoming a medical registrar participated. Quantitative and qualitative analysis of participants' written feedback showed a significant pre- to post-course increase in candidates' self-reported confidence in undertaking the medical registrar role along with learning in non-technical skills.

Discussion

This course was shown to be effective in helping to improve the confidence of trainees approaching the medical registrar role. The carefully designed standardised format may facilitate wider expansion of such training.