 A training initiative in the Scottish Highlands is using a novel approach to deliver education in a time-constrained system
In May, the College joined forces with healthcare and educational organisations from across Scotland to deliver a training event with a twist – the first Highland Surgical Boot Camp.
Six days in a boot camp wouldn’t normally be regarded as an appealing prospect, but in this case the invitation was readily taken up by nine trainees from England, Ireland and Scotland, embarking upon their surgical careers.
The boot camp drew on the specialist skills (general, trauma and orthopaedics, and postgraduate education) of faculty from the North of Scotland and across the UK, to deliver a residential, intensive course at the Clinical Skills Centre in Inverness.
Run jointly by Inverness’ Centre for Health Sciences, NHS Highland, the RCSEd and The University of Aberdeen, the course is designed to give a head-start in the technical, non-technical and communication skills required for a competent surgical trainee.
The course provided didactic teaching, small interactive group sessions and research methodology with wet laboratory technical skills, ward round moulages and communication skills scenarios.
Particular components included a daily early morning journal club, planning a surgical career, literature search, using ISCP and how to get the most out of surgical training and the trainer. Important emphasis, especially valued by the trainees, was placed on non-technical skills such as situational awareness, decision-making, communication, teamwork and leadership.
Highlights included lectures from a battlefield-experienced trauma surgeon who conveyed his field experience with trauma teaching. The week is augmented with a day of outdoor activities and evening Highland dining with invited speakers.
Faculty members and delegates commented: ‘Over recent years there have been fundamental changes within the health service causing significant challenges with the delivery and quality of surgical training. Time constraints enforced by the European Working Time Directive and reduced number of years in training have affected the range and level of competence of surgeons completing training.
‘The old apprentice-style teaching, of learning by ‘osmosis’, is no longer suited to the modern day. Current post-graduate education is focused on how we deliver teaching on required technical and, perhaps more importantly, non-technical skills in a formal manner. It is known that non-technical skills are fundamental to patient safety and early success as a trainee.’
Similar courses have been held for junior trainees in other countries, (in paediatrics, neurosurgery, obstetrics and gynaeacology and orthopaedics) and have been effective in improving self-confidence, surgical skills and clinical performance. One RCT study from the USA demonstrated accelerated competency in basic technical skills compared with those who did not undergo a three-day technical-based skills boot camp.
The organisers believe the course has demonstrated that intensive boot camp-style skill training for surgery is an effective and fun way to deliver education in a time-constrained system. It improves self-perceived confidence and technical and non-technical junior surgical ability. The format is well received by students, with one delegate commenting, ‘Every element of the course allowed us to develop different skills’. The course has proved popular with the faculty too, and is being expanded to include other clinical disciplines. Validation work will proceed over coming Boot Camps.
References
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Nishisaki A, Hales R, Biagas K, Cheifetz I, Corriveau C, Garber N, et al. A multi-institutional high-fidelity simulation "boot camp" orientation and training program for first year pediatric critical care fellows. Pediatr Crit Care Med 2009 Mar;10(2):157-162.
Selden NR, Barbaro N, Origitano TC, Burchiel KJ. Fundamental skills for entering neurosurgery residents: report of a Pacific region "boot camp" pilot course, 2009. Neurosurgery 2011 Mar;68(3):759-64; discussion 764.
Pliego JF, Wehbe-Janek H, Rajab MH, Browning JL, Fothergill RE. OB/GYN boot cAMP using high-fidelity human simulators: enhancing residents' perceived competency, confidence in taking a leadership role, and stress hardiness. Simul Healthc 2008 Summer;3(2):82-89.
Sonnadara RR, Van Vliet A, Safir O, Alman B, Ferguson P, Kraemer W, et al. Orthopedic boot camp: Examining the effectiveness of an intensive surgical skills course. Surgery 2011 Jun;149(6):745-749.
Esterl RM,Jr, Henzi DL, Cohn SM. Senior medical student "Boot Camp": can result in increased self-confidence before starting surgery internships. Curr Surg 2006 Jul-Aug;63(4):264-268.
Parent RJ, Plerhoples TA, Long EE, Zimmer DM, Teshome M, Mohr CJ, et al. Early, intermediate, and late effects of a surgical skills "boot camp" on an objective structured assessment of technical skills: a randomized controlled study. J Am Coll Surg 2010 Jun;210(6):984-989.
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