Are Boot Camps an Effective Teaching Modality for Junior Otolaryngology Residents?

On-call emergencies in otolaryngology can be life-threatening and are often time-sensitive. Junior otolaryngology residents are often the first on scene in these critical situations, which can be challenging if they have not previously encountered such pathologies. To help residents acclimatize to this transition, intensive, 1-day courses (“boot camps” or “bootcamps”) have been utilized. These courses provide structured, simulated hands-on learning opportunities designed to enhance trainee preparedness for low-frequency high-acuity situations. This review examines the effectiveness of otolaryngology boot camps and assesses their value for junior residents. The first documented otolaryngology boot camp was reported in 2011 [1]. This landmark paper described the boot camp's overall concept and structure. In total, 27 residents participated in this initiative, of which 24 completed three post-course surveys. The study showed a significant increase in confidence across all eight learning modules, with the strongest gains in cricothyroidotomy and management of complex airway pathology. The improvement in confidence was largely sustained 6 months later, though the benefit for cricothyroidotomy diminished over time. While this study supports the utility of a boot camp for improving trainee confidence, limitations included a small sample size and a lack of validated assessment. In 2012, the Canadian iteration of the boot camp was first introduced in London, Ontario. The program combined didactic lectures, expert panel discussions, and hands-on experience using task trainers and simulation models. The initial survey study of 28 participants assessed the realism of the various task trainers [2]. Six of the seven task trainers were rated “very good,” with only the post-tonsillectomy bleeding model being rated inferior. The team simulation scenarios were similarly deemed valuable, with ratings between “very good” and “outstanding.” Moreover, participants suggested that the boot camp was relevant to their practice, and 93% of respondents suggested they would recommend this course to their junior residents (the remaining 7% left the question blank). While this study suggests the boot camp structure and content are appropriate and relevant to learners and highly regarded, a limitation is that it did not evaluate confidence or performance. To address a limitation of the prior study, a follow-up study assessed 22 residents before and after the second iteration of the Canadian course [3]. Participants were asked to rate their confidence in performing various tasks and procedures before and after the boot camp, using a 5-point Likert scale. Ultimately, the authors found the mean confidence score increased significantly for six of the nine procedures. These findings aligned with those from the Georgetown boot camp study [1], suggesting that such training programs improved self-reported confidence with certain procedures, though it remained uncertain if this translated to an increase in skill [3]. In 2016, Smith et al. published the results of their UK boot camp [4]. In their study, 18 residents participated in their boot camp, of which 17 completed a pre- and post-boot camp knowledge assessment with multiple choice questions focused on the management of otolaryngology emergencies (in addition to asking about confidence). They found that knowledge test scores were significantly higher after participation than before; the increase in score ranged from 0% to 48%. Consistent with prior studies [1, 3], all participants also felt more confident handling otolaryngology emergencies. This study uniquely demonstrated that boot camps can enhance not only confidence but also knowledge acquisition. Nonetheless, its limitations included a small sample size and the uncertain relationship between knowledge improvement and real-world clinical performance. Building upon this, a prospective single-blinded cohort study was published by Swords et al. in 2017 [5]. Thirty-seven junior doctors from otolaryngology and related fields (i.e., emergency medicine, anesthesiology) rated their confidence in managing a variety of otolaryngology pathologies before, immediately after, and 2 months after a boot camp course. Further, video-recorded simulation scenarios were evaluated by otolaryngologists who were blinded to the course, and they evaluated the participants on their effectiveness in the scenario. Consistent with prior studies [1, 3, 4], participant confidence was higher on the post-boot camp scenario and this gain was maintained 2 months later. More importantly, objective assessments demonstrated notable improvement in performance in the clinical scenarios, as rated by the blinded reviewers. This study suggests boot camps enhance not only confidence but also clinical competency. Again, the sample size was somewhat limited and there was heterogeneity in the cohort. The available evidence demonstrates that boot camps are well-received and viewed as highly valuable by trainees [2]. As well, boot camps have been shown to be effective at improving trainee confidence, with benefits persisting at least 6 months after participation [1, 3-5]. Additionally, there is emerging evidence that boot camps can enhance knowledge acquisition [4] and performance in simulated clinical scenarios [5]. In conclusion, otolaryngology boot camps provide an effective training model for junior residents, fostering confidence, knowledge, and, to some extent, clinical skills. Despite these promising findings, further research is needed to determine whether increased confidence and knowledge translate into improved real-world clinical performance. Future studies should focus on long-term clinical outcomes, standardized assessment tools, and the development of validated performance metrics. The evidence in this review includes five prospective cohort studies (Level 2) [1-5]. The authors have nothing to report. Christopher J. Chin: Advisory board, speaker: GSK, Sanofi-Regeneron, AstraZeneca. The other authors declare no conflicts of interest.

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