V. M. Jones1, E. X. Chen1, J. L. Raque1, E. Sutton1 1University Of Louisville,Department Of Surgery,Louisville, KY, USA
Introduction: Surgical residents are given autonomy early in their training, often with limited direct supervision. The Core Entrustable Professional Activities for Entering Residency (CEPAER, Figure 1) were developed to reduce the gap “between what new residents do without supervision and what they have been documented as competent to do without supervision.” We describe use of a surgical bootcamp to document achievement of CEPAER in medical students entering surgical residency.
Methods: Prior to the course, a focus group about course expectations, including a pre-test of confidence and knowledge about communication and patient care was given. Medical students pursuing surgical residency then completed the 4-week course in the spring of their fourth year. The course featured didactic and hands on instruction in airway management, venous access, surgical technique, obtaining informed consent, radiography interpretation, and obstetric, orthopedic, and plastic surgery emergencies. Educational tools used to teach the course included part task trainers, patient simulators, standardized patients, and direct observation/instruction. Students also participated in the MedEdPortal course “Death on the Wards” and a mock call program administered by two registered nurses. A post course focus group and posttest was conducted. Student achievement of the CEPAER was documented by faculty daily.
Results:We were able to document competency, defined as direct observation of skill without supervision, for all EPAs except numbers 6, 7, and 13, for a total of 10/13 EPAs (77%). Four of nine students were not able to complete the Advanced Cardiac Life Support (ACLS) algorithm (representing EPA 10) for a standardized patient simulation involving myocardial infarction. A two-day refresher course in ACLS was then given in which all students successfully demonstrated competence.
The “Death on the Wards” course significantly increased student confidence and knowledge regarding communication and administrative responsibilities surrounding patient death. The average assessment of confidence prior to the workshop was 19.78 ± 4.41 (SEM 1.47). After bootcamp, the average was 31.56 ± 4.48 (SEM 1.49) (p < 0.01). The average assessment of knowledge prior to the workshop was 16.11 ± 3.95 (SEM 1.32). After bootcamp, the average was 31.33 ± 6.12 (SEM 2.04) (p < 0.01).
Conclusion:Surgical bootcamps serve as a framework for documenting achievement and offering remediation of CEPAER. Further course development can ensure all entrustable professional activities are included in the curriculum.
