2008 Annual Meeting Abstracts
BOOT CAMP: Implementation of an Intensive Simulation-based Educational Curriculum for New Surgical Interns
Gladys L. Fernandez, MD, Neal E. Seymour, MD, Richard B. Wait, MD, PhD, Patrick C. Lee, MD, Loki Skylizard, MD, Myron St. Louis, MD, Ronald Bush, BS, David W. Page, MD.
Baystate Medical Center, Springfield, MA, USA.
Objective: In order to rapidly improve new surgical trainee skill at the onset of employment, we initiated an intensive preparatory training experience for starting post-graduate year (PGY) 1 surgical residents at Baystate Medical Center and report early performance results of this training.
Design: Subject-controlled trial
Setting: University affiliated community hospital
Participants: 8 surgical PGY-1s
Interventions: BOOT CAMP consisted of 8 procedural skills and simulated patient care exercises during weekly 3-hour skills lab sessions over 9 weeks. These consisted of instrument use, knot-tying, suturing, laparoscopic skills, airway management, central venous catheter and chest tube insertion, and patient care problems (shock, respiratory, cardiac, and trauma management) using high- and low-tech simulations. Faculty and senior residents served as teachers.
Main Outcome Measures: Baseline cognitive skills were assessed with written tests on basic patient management. Post-BOOT CAMP tests similarly evaluated cognitive skills. In addition, technical skills were expressed as a mean score for all activities for each resident. These were compared to test results for PGY-2s who had not received BOOT CAMP training (unpaired t-tests).
Results: 75% of residents improved their cognitive skills test scores over the 9 weeks’ training. There was great variability in technical skills among PGY-1s (mean post-training scores 71±13% SD; range 53-82%), and 2 residents’ technical skills were below the lower 95% confidence limit. PGY-2 technical skills scores remained better than PGY-1 scores (82±1 vs 71±4; p<0.05) but written exam scores were similar.
Conclusions: A procedural and cognitive training curriculum for new PGY-1 surgical residents was successfully implemented. Variations in performance were noted, with early indications of performance outlier behavior that have directed efforts to facilitate peer-appropriate performance.