S. Liu1, J. Unkart1, D. Hemming1, B. Sandler1, G. Jacobsen1, J. Baumgartner1 1University Of California – San Diego,Surgery,San Diego, CA, USA 1University Of California – San Diego,Surgery,San Diego, CA, USA
Introduction: An internship in surgery requires clinical communication and decision-making skills not adequately covered in the standard medical curriculum. This study investigates the immediate and ongoing effect of a month long course for 4th year medical students entering surgical residencies taught by a combination of attendings and residents.
Methods: This is a prospective study on the effect of a 4 week elective course (“Boot Camp”) designed to prepare medical students for a surgical internship. The course is modeled after the American College of Surgeons Resident Prep Curriculum created for 4th year medical students entering surgical residency. The curriculum included an average of 6 hours of course work per day divided into didactics, skills labs, and operative anatomy (cadaver and porcine) sessions taught by surgical attendings and residents. Students were evaluated for their confidence, ability to triage pages, ability to decide when to call for senior resident or attending backup when on call, and ability to effectively selective information to signout to a colleague. This was done before, after, and at 3 months follow-up.
Results: A total of 9 students were enrolled in the course (4 general surgery, 2 ENT surgery, 2 neurosurgery, and 1 plastic surgery). The progression of confidence on various subjects is seen in the graph below from a scale of 0-100% confident. There was an average overall increase in confidence which rose from 49% ± 6.8% at baseline to 65.7% ± 7.9% immediately at the end of boot camp (P<0.001). However, the average change from baseline at 3 months (54.1% ± 11.6%) was not significant (P=0.288). Test scores on exams designed to assess student ability to prioritize clinical acuity and identify important clinical information during signout did not show significant improvement at either time point. Tests of decisions to call a senior resident or attending backup found rates of over-calling increased from 3.3% to 8.3% and to 10.6% (P=0.025) at the three time points. The rates of under-calling did not change significantly (10% to 12% to 8.8%).
Conclusion: A month long surgical boot camp for 4th year medical students had a significant effect in boosting immediate confidence in their clinical abilities and preparedness for internship . The tendency to overcall senior backup increased at follow-up in concordance with decreased confidence. These findings suggest the need for additional intervention after the boot camp in order to achieve sustained effects in medical student confidence and clinical reasoning before internship.
