“Surgical Bootcamp” – A Pre-Residency Preparatory Course for Residents from Surgical Specialties: The Israeli Experience

Dan Prat 1,5 Imri Amiel 1,2 Roy Mashiach 3 Ziv Amitai 1,4 Gutman Mordechai 2
1MSR, Israel Center for Medical Simulation, Sheba Medical Center, Tel-Hashomer, Israel
2Surgery Department B,, Sheba Medical Center, Tel-Hashomer, Israel
3Department of gynecology,, Sheba Medical Center, Tel-Hashomer, Israel
4Department of Medical Education, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
5Department of orthopaedic surgery, Sheba Medical Center, Tel-Hashomer, Israel

Background: A century after Halsted inaugurated the first surgical residency, the apprenticeship model of “see one, do one, teach one” is wearying at the era when patient safety comes first. In America, with the reported success of simulation training in the surgical literature, the American Board of Orthopaedic Surgery (ABOS) required that surgical simulation training be a component of the curricula in orthopedic residencies. Working hours regulations have shortened the residency, yet more procedures are required to be mastered. Surgical education is becoming competency based, time and cost efficient, and is aspiring to introduce better pre-trained doctors into hospitals.

Objectives: Implementation of a pre-residency surgical preparatory course in Israel. Objectively assess the participants’ surgical skills.

Methods: During 2013-2014, three surgical Boot-camps were conducted at MSR, the Israeli Center for Medical Education. Residents from orthopedics, general surgery, OBGYN, urology, plastic surgery, neurosurgery and ENT were enrolled. The 5-days course incorporated aspects of basic surgical skills and included a practical exam at the end.

Results: 32 residents with the average age of 31.3 (SD 2.5) participated, averaging 3.2 months in residency (SD 3.48). Subjective competence grew in interrupted skin sutures proficiency from 2.53 (SD 0.84) on a Likert 1-4 scale to 3.25 (SD 0.72) with a P-value 0.0005. Surgical tie knotting competency rose from 2.22 (SD 0.94) to 2.97 (SD 0.78), P-value 0.001. Most of the residents thought that the surgical boot-camp assisted them in a considerable degree (average 3.9 of 4 (SD 0.3)), and unanimously pointed that they would strongly suggest to include this practice in residency programs in the future (average 4 of 4).

Conclusions: Pre-residency boot-camp is a desirable way to introduce new interns to the health system, providing them with important tools needed in the beginning of their residency, minimizing the extent of mistakes and enhancing patient safety.