Does a boot camp expand skills rapidly?

Abstract

Central MessageInnovations like Boot Camp complement resident education.See Commentary on page 296.In addition to the sound judgment essential to the clinical management of our patients, all surgical specialties require a foundation of technical skills that is difficult to acquire without direct patient experience. Nowhere is this more evident than in cardiothoracic surgery, where even the most elementary cases have fundamental technical demands considerably above that experienced or practiced as a medical student. The skills necessary to isolate and cannulate the great vessels are a far cry from closing skin with a subcuticular suture. Even during the days when surgical residency was routinely longer than a decade and cardiothoracic training did not begin until after the completion of general surgery, the jump-in technical complexity for the trainee was substantial. Over the years, the difficulty has only increased. Lung resections previously performed via open thoracotomy are now routinely performed using thoracoscopic or robotic techniques. Mitral replacements through a sternotomy are a rarity compared with valve repairs from the side. Congenital surgeons are now expected to perform neonatal operations with previously unheard-of expectations of mortality.Yet despite the duty-hour restrictions demanded by the Accreditation Council for Graduate Medical Education and the recent transition of many programs to an integrated 6-year (I-6) residency, recent graduates are arguably better than ever. It has certainly been our experience that although I-6 trainees are not only considerably less experienced and have vastly less time to learn in the hospital, their clinical capabilities, technical abilities, and depth of understanding have matched those of previous generations by the time they graduate.For us, 2 essential changes occurred that helped our surgical residency adapt to the changing face of medical education and changed the direction of training for our residents. First and foremost was the acceptance and recognition that the purpose of surgical residency was for the education of the trainee rather than for the clinical enterprise of the institution. Second was the recognition that, for the most part, our trainees were dedicated and mature learners who, given the opportunity, would take the responsibility of their education into their own hands outside of the hospital. Of course, all of us have been disappointed at times with the effort that some residents have put into self-directed learning, but when validated educational opportunities such as a clinical boot camp fall in line with smart, capable, highly motivated residents, the results can be rapid, highly effective gains in knowledge, confidence, and ability.In 2008, following efforts by each of the national cardiothoracic surgery organizations to develop and institute a new educational model for surgical training, the Joint Council for Thoracic Surgery Education and the Thoracic Surgery Directors Association created the first cardiothoracic surgery “Boot Camp.” Since its inception, about 30 residents per year have participated in the course. Using both simulation and didactic sessions over a 2- and a half-day course, the Boot Camp program provided an opportunity for surgical residents to gain exposure to some of the fundamental techniques in cardiothoracic surgery under direct supervision of practicing surgeons. The areas of emphasis were coronary anastomoses, cardiopulmonary bypass and cannulation, pulmonary resection, bronchoscopy and mediastinoscopy, and aortic valve surgery. The curriculum was meticulously orchestrated to maximize the efficacy of training for new trainees.1Nesbitt J.C. St. Julien J. Absi T.S. Ahmad R.M. Grogan E.L. Balaguer J.M. et al.Tissue-based coronary surgery simulation: medical student deliberate practice can achieve equivalency to senior surgery residents.J Thorac Cardiovasc Surg. 2013; 145: 1453-1458Abstract Full Text Full Text PDF PubMed Sco