Board 214 - Program Innovations Abstract Title

Introduction/Background Recent developments within the medical education system are having a stifling effect on surgical training. Reduced work hours1-3 for surgical trainees, coupled with an increased focus on patient safety inevitably Results in fewer educational opportunities and decreased quality of learning experiences for new trainees. Today’s surgical educators are actively searching for learning opportunities that extend beyond the operating room. Simulation-based programs allow practice at an individual pace in a risk-free environment and present an important supplement to traditional clinical teaching.4-7 One such program is the Surgical Prep Camp (SPC), a new simulation-based course that aims to prepare all incoming surgical trainees at the University of Toronto for their residency. The Surgical Prep Camp was developed by experts in surgical education and skill acquisition and has evolved from the award-winning Toronto Orthopaedic Boot Camp program.8-9 Methods All 54 first year surgical trainees participated in SPC, which took place at the onset of their residency. The program was delivered at the University of Toronto Surgical Skills Centre at Mount Sinai Hospital. The Surgical Prep Camp program focused on core skills that Program Directors agreed were essential for all surgical residents and created a unique learning environment to accelerate the development of these skills. For two weeks, residents from all specialities practiced suturing, central line insertion, surgical airway and other fundamental skills. The program also included didactic sessions encompassing key concepts in surgery. These two weeks were followed by an additional training period (the length of which was determined by each surgical division) which focused on developing speciality-specific skills. Trainees’ progress was closely monitored. Throughout the course, the residents and instructors were encouraged to complete interim skills assessments using electronic progress logs. Upon completion of the SPC program, trainees completed a skills examination. A retention examination will be conducted in eight months time to determine how well the skills persist. Additionally, extensive feedback was collected to help improve future iterations of SPC. We present preliminary data from our early experiences with SPC. Skills examination performance Results were impressive with a normalized mean total checklist score of 0.85 (0.15) (out of a possible 1). Nonetheless, two tasks (chest tube insertion and tracheostomy) proved to be particularly challenging. We also present detailed feedback from our residents and staff which will offer insight into the program’s development and implementation. Results: Conclusion The ultimate goal of SPC is to enhance patient safety and produce more competent surgeons who are better prepared for clinical practice. This program provides new trainees with a sound foundation upon which they can build their technical and clinical skills. Beyond providing an advantage at the beginning of training, the program seeks to instill effective learning habits that allow residents to engage in meaningful deliberate practice. Focusing on technical skills at the beginning of residency aims to allow trainees to advance to more complex tasks earlier within residency, which provides a much richer educational experience than has previously been possible.10 This is achieved in a manner which does not produce significant additional load on faculty since the teaching is shared between staff surgeons, fellows, senior residents and members of the allied healthcare team. Both this program and its predecessor have generated much interest in the surgical education community. Early evidence suggests that simulation-based programs can have a profound positive impact on residency training across all specialities. We believe that more widespread adoption of such programs will follow, helping to ensure that our future surgeons are better prepared to face the challenges that lie ahead. References 1. Calman KC, Temple JG, Naysmith R, Cairncross RG and Bennett SJ: Reforming higher specialist training in the United Kingdom - a step along the continuum of medical education. Med Educ 1999; 33: 28–33. 2. Pickersgill T: The European working time directive for doctors in training. BMJ 2001; 323(7324):1266. 3. Irani JL et al.: Surgical residents’ perceptions of the effects of the ACGME duty hour requirements 1 year after implementation. Surgery 2005; 138(2):246-253. 4. Carter BN: The fruition of Halsted’s concept of surgical training. Surgery 1952; 32(3): 518–527. 5. Reznick RK, MacRae H: Medical education - Teaching surgical skills - Changes in the wind. N Engl J Med 2006; 355(25): 2664–2669. 6. Ericsson KA, Krampe RT, Tesch-romer C: The role of deliberate practice in the acquisition of expert performance. Psychological Review 1993; 100(3): 363–406. 7. Ahlberg G, Enochsson L, Gallagher AG, et al.: Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 2007; 193(6):797–804. 8. Sonnadara RR, Van Vliet A, Safir O, et al.: Orthopedic boot camp: examining the effectiveness of an intensive surgical skills course. Surgery 2011; 149(6): 745–749. 9. Sonnadara RR, Garbedian S, Safir O, et al.: Orthopaedic Boot Camp II: examining the retention rates of an intensive surgical skills course. Surgery 2012; 151(6): 803–7. 10. Sonnadara RR, Garbedian S, Safir O, Mui C, Mironova P, Nousiainen M, Ferguson P, Kraemer W, Alman B and Reznick R: Orthopaedic Boot Camp III: Examining the efficacy of self-regulated learning during an intensive laboratory-based surgical skills course. Surgery (In Press). Disclosures None.

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