BOOT CAMP: Educational Outcomes After
Four Successive Years of Preparatory
Simulation-based Training at Onset of Internship
Gladys L Fernandez MD, Richard B Wait MD PhD, Nicholas P Coe MD, David W Page MD,
Patrick C Lee MD, Lisa Patterson MD, Marisa H Amaral MD, Neal E Seymour MD
Tufts University School of Medicine
Baystate Medical Center, Springfield, MA
Baystate Simulation Center, ACS-accredited Level I Education Institute
2011 APDS Annual Meeting, Boston, MA
Objectives
• Describe our PGY-1 BOOT CAMP
• Discuss aims and methods of preparatory
simulation-based program
• Describe program experiences and
educational outcomes
Surgical PGY-1 BOOT CAMP
• Preparatory simulation-based training
implemented at the onset of internship
• Introduction of cognitive and procedural skills
necessary for basic surgical patient problem
assessment and management
Program Structure
• Trainees
– All PGY-1 residents
• Teaching faculty
– Surgical
– Non-surgical
– PGY-5 residents
– Specialty area clinical nurse educators
– Simulation center staff
Program Structure
• Needs assessment
– Literature review of orientation practices
– Departmental PGY-1 roles & responsibilities
– ACGME common program requirements
Program Structure
• Curriculum Design
– Weekly 4 hour training sessions over 9 weeks
– Objectives-based cognitive skills
– Objectives-based procedural skills
– Extensive formal assessment and testing
Boot Camp Curriculum Areas
PROCEDURAL SKILLS
•
•
•
•
•
•
•
•
Suturing & Knot-tying
Airway management
Tube thoracostomy
Central venous access
Essentials of ACLS
Ventilator management
Invasive monitoring
Basic Laparoscopic skills
PATIENT CARE SKILLS
•
•
•
•
•
•
•
•
•
•
Volume & Electrolyte disturbances
Respiratory distress
Arrhythmias & Cardiac arrest
Critically ill patient care
Shock & Shock states
Surgical emergencies
Perioperative fever
Adverse reactions
Trauma patient care
Extremes of age
Reading Assignment
Testing
Week 1
Reading Assignment
Week 8
Basic Laparoscopic
Skills
Adverse
Reactions
Chest Tube
Respiratory
Distress
Airway
Comorbidity
Management
ACLS
Cardiopulmonary
Arrest
Ventilator
Management
Surgical
Emergencies
Basic Suturing &
Laparoscopic Skills
Extremes
Of Age
Testing
Week 7
Reading Assignment
Shock States
Testing
Week 6
Reading Assignment
CVC Insertion
Testing
Week 5
Reading Assignment
Hypovolemia
Resuscitation
Testing
Week 4
Reading Assignment
Instrument Handling
Suturing & Knot Tying
Testing
Week 3
Reading Assignment
Management
Testing
Week 2
Reading Assignment
Procedural
Testing
Reading Assignment
Week 9
Testing
Program Structure
Assessment
– Weeks 1-8
• Weekly written pre-tests
• Procedural skills assessments
• Patient simulation performance assessments
– Week 9 - Final Exam
• Skills Station Assessments
Airway
CVC insertion
Laparoscopic skills
Extremes of Age
• Written Exam
Chest tube
Suturing & Knot tying
CXR & EKG review
Situational Awareness
Results
• July 2007—2010
• 30 PGY-1 residents
• BOOT CAMP performance
–
–
–
–
Written pretests
Skills assessments
Final written examination
Final skills stations assessments
Residency Performance Evaluations
– Weekly core curriculum quizzes
– PGY-1 ABSITE scores
– New InnovationsTM cognitive evaluations
– New InnovationsTM technical skills evaluations
– OP-RateTM technical skills evaluations
BOOT CAMP Pretest & Final Written
Examination Performance
BC Final Written Examination
100
90
80
70
60
50
50
60
70
80
BC Pretest
Spearman correlation, r=0.56, p=0.0006
90
100
BOOT CAMP Final Written Examination and
ABS In-Training Examination Performance
100
90
80
ABSITE
70
60
50
40
30
20
10
70
80
90
Final Written Exam
Spearman correlation, r=0.49, p=0.01
100
BOOT CAMP Technical Skills and
New Innovations Technical Skills Performance
90
New Innovations Technical Skills
80
70
60
50
40
30
40
50
60
70
BC Technical Skills
Spearman correlation, r=0.58, p=0.002
80
90
100
BOOT CAMP Technical Skills and
OP-RATE Technical Skills Performance
OP-Rate Technical Skills
80
70
60
50
70
80
BC Technical Skills
Spearman correlation, r=0.69, p=0.01
90
• We did not find statistically significant
correlation in performance comparisons for
– BOOT CAMP written examination results &
Weekly core curriculum quizzes
– BOOT CAMP written examination &
New InnovationsTM cognitive skills evaluations
Conclusions
• Individual BOOT CAMP performance scores for
cognitive and procedural skills assessments correlate
with subjective and objective clinical performance
evaluations.
• Concurrent correlation with multiple traditional
evaluation methods supports the use of BOOT CAMP
performance measures
– Needs assessment tools
– Adjuncts to cumulative resident evaluation data
Conclusions
• Future Directions
– Program evaluation
– Curriculum expansion
– Curriculum implementation in light of updated
duty hours regulations
BOOT CAMP: Educational Outcomes After
Four Successive Years of Preparatory
Simulation-based Training at Onset of Internship
Gladys L Fernandez MD, Richard B Wait MD PhD, Nicholas P Coe MD, David W Page MD,
Patrick C Lee MD, Lisa Patterson MD, Marisa H Amaral MD, Neal E Seymour MD
Tufts University School of Medicine
Baystate Medical Center, Springfield, MA
Baystate Simulation Center, ACS-accredited Level I Education Institute
2011 APDS Annual Meeting, Boston, MA