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Original Investigation |

Implementation of an Intern Boot Camp Curriculum to Address Clinical Competencies Under the New Accreditation Council for Graduate Medical Education Supervision Requirements and Duty Hour Restrictions

Aleksandra Krajewski, MD1; Dawn Filippa, MSN2,3; Ilene Staff, PhD3; Rekha Singh, MD4; Orlando C. Kirton, MD1,3
[+] Author Affiliations
1Department of Surgery, University of Connecticut School of Medicine, Farmington
2Center for Education, Simulation, and Innovation, Hartford Hospital, Hartford, Connecticut
3Department of Surgery, Hartford Hospital, Hartford, Connecticut
4The Hospital of Central Connecticut, New Britain
JAMA Surg. 2013;148(8):727-732. doi:10.1001/jamasurg.2013.2350.
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Importance  Today’s general surgery interns are faced with increased duty hour restrictions and stringent competency-based supervision milestone requirements (ie, from direct to indirect supervision). Working within these constraints, we instituted a unique 2-month intern curriculum (boot camp) incorporating knowledge-based, experiential, and practical components.

Objectives  To describe our curriculum and the effect on resident performance and teaching faculty and nursing staff perceptions.

Design  All interns underwent a 2-month (July and August 2011) boot camp curriculum consisting of two 2½-hour knowledge-based and procedural skills (SimMan) didactic sessions per week and completion of 25 core intensive introductory American College of Surgeons Fundamentals of Surgery web-based self-study modules, followed by a standardized patient clinical skills assessment.

Setting  Integrated general surgery residency program at the University of Connecticut School of Medicine, Farmington.

Participants  Postgraduate year 1 general surgery categorical and preliminary residents.

Main Outcomes and Measures  : We used several assessment tools, including an intern boot camp survey, clinical skills assessment scores, intern American Board of Surgeons In-Training Examination scores, and nursing staff and teaching faculty surveys of intern performance and aptitudes compared with the previous year’s interns. Data were analyzed by independent group t test, χ2 tests of proportions, and Fisher exact test for small sample cross tables.

Results  In total, 84% (91 of 108) of intern respondents agreed or strongly agreed with the usefulness, relevance, and execution of the boot camp. Compared with the previous year’s interns, the nursing staff agreed or strongly agreed that the cohort interns were better at patient assessment, collaboration, and effective communication and provided compassionate and respectful patient care. More than 40% (7 of 17) of surveyed teaching faculty agreed or strongly agreed that the cohort interns demonstrated better patient care and procedural skills and self-confidence compared with the previous year’s interns. The clinical skills assessment scores after the 2-month boot camp paralleled the scores typically seen at the end of the previous 2 internship years (P > .25 for all). The proportion of nondesignated and categorical interns pursuing careers in general surgery scoring in the top quartile on the American Board of Surgery In-Training Examination increased from 7% (2 of 28) to 50% (5 of 10) compared with the previous 2 internship years (P = .01).

Conclusions and Relevance  Recent changes in intern duty hours and supervision rules mandate that residency training programs must institute a competency-oriented curriculum to provide interns with the necessary knowledge and practical skills to attain clinical competence.

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Figure 1.
Components of the Intern Boot Camp Curriculum

GI indicates gastrointestinal.

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Figure 2.
Clinical Skills Assessment Scores
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Figure 3.
Proportion of Nondesignated and Categorical interns Pursuing Careers in General Surgery Scoring in the Top Quartile on the American Board of Surgeons In-Training Examination

The percentages in the top quartile were 0% (0 of 9) in 2009, 11% (1 of 9) in 2010, 10% (1 of 10) in 2011, and 50% (5 of 10) in 2012.

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