Boot Camp in a Box: Initial Experience with Pretraining Skills Preparation for New Interns

J Surg Educ. 2019 Nov-Dec;76(6):e225-e231. doi: 10.1016/j.jsurg.2019.07.019. Epub 2019 Aug 27.


Purpose: In order to increase selected skills at onset of training, we provided newly matched PGY-1 trainees with materials and instructions to practice these skills, as well as the opportunity to share video-recorded performance and receive feedback based on these videos.

Methods: Knot tying and suturing kits, instruments and supplies, and video instructions for task performance were sent to newly matched trainees to our program (n = 10), with instructions to practice 4 tasks (1- and 2-handed knot tying, interrupted and running suturing) until self-assessed comfort with each task was achieved or the 8-week time point before start of training was reached. Each trainee returned a video of each task, which was graded by blinded reviewers for time and errors using an itemized evaluation instrument (12 items for suturing and five items for knot-tying). Feedback (annotations of submitted videos) was provided after grading was completed. Task performance was repeated and reassessed at the time of new intern "Boot Camp" and again 8 weeks after start of training. Performance scores were compared for the 3 time points and with scores of PGY 2-4 residents using ANOVA with posthoc tests.

Results: Compliance with instruction for practice and return of video recorded tasks in the months before start of PGY-1 training was high, with only 1 of 10 failing to return knot-tying videos. A significant pattern of performance change (p < 0.05) was observed for all tasks with an initial decrease between the pre-employment practice period and the Boot Camp test followed by an increase to the highest level of performance 2 months after start of training. At that point, scores were not significantly different than those of more senior residents.

Conclusions: A high level of compliance was achieved with requested skills practice and video documentation of performance. We attribute the consistently lower scores on the tasks during Boot Camp tests to higher stress test environment which was apt to be less favorable than having the trainee choose to submit their best possible preresidency video recording of performance in a low-stress situation. Subsequent achievement of significantly higher performance even compared to more senior residents may have been helped by incentivized pretraining practice.

Keywords: Boot camp; Patient Care; Performance feedback; Practice-Based Learning and Improvement; Professionalism; Skills assessment; Surgical education.

MeSH terms

  • Clinical Competence*
  • Curriculum
  • Education, Medical, Graduate*
  • Educational Measurement / methods*
  • Equipment and Supplies / economics
  • Formative Feedback
  • Humans
  • Internship and Residency
  • Massachusetts
  • Self-Assessment
  • Suture Techniques / education*
  • Video Recording