C. J. Neylan1, K. R. Dumon1, I. W. Folkert1, D. T. Dempsey1, J. B. Morris1, N. N. Williams1, S. R. Allen1 1University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA
Introduction: The ACS, ASE, APDS, and ABS recently published a joint statement supporting the implementation of surgical pre-residency preparatory courses by medical schools in the United States. Over the past two decades, many medical schools have started offering a surgical ‘boot camp,’ or surgical capstone course, in the fourth year of medical school in an effort to improve students’ performances when they begin surgical internship. The purpose of this study was to perform a comprehensive review of the literature to date evaluating the effects of a surgical boot camp.
Methods: Multiple searches of Pubmed were conducted to identify published papers to August 2015. Key search terms included surgical boot camps, capstone courses, and medical education reform. Abstracts and presentations at meetings were not included. Relevant articles were categorized by their method of evaluating boot camp outcomes.
Results: 14 studies evaluated the outcomes of surgical boot camps. Of these studies, 10 evaluated the impact of boot camps by rating student/intern confidence, while 8 assessed student/intern competence (2 studies evaluated both confidence and competence). The 10 studies that assessed confidence were unanimous in their finding that boot camps increase student and intern confidence. The 8 studies that assessed competence were unanimous in their finding that boot camps increase performance (on exams, procedures, or clinical tasks). However, only 3 of these 8 studies followed-up on performance into the intern year. These 3 studies assessed the competence of interns either by subjective methods (e.g. Likert scale ratings) or objective methods (e.g. OSCE scores), and the assessments occurred either in the simulated setting or the clinical (i.e. hospital) setting, as far as 6 months into internship. One study used objective and subjective methods to evaluate 29 interns in a simulated setting; another study used objective methods in a simulated setting and subjective methods in a hospital setting (n = 84 interns); the third study used objective methods in a simulated setting (n = 19 interns). None of these 3 studies evaluated intern competence using objective methods in the hospital setting.
Conclusion: Despite the demonstrated success of boot camps in improving the confidence of students and interns, the effect of a surgical boot camp on the actual clinical or operative performance of interns in a non-simulated hospital setting has not been studied. Further research is needed to objectively evaluate the effect of surgical boot camps on intern competence and clinical performance in the real world hospital setting.
