1. BOOT CAMP: Educational Outcomes After Four Successive Years of Preparatory Simulation-based Training at Onset of Internship Gladys L Fernandez MD, Richard B Wait MD PhD, Nicholas P Coe MD, David W Page MD, Patrick C Lee MD, Lisa Patterson MD, Marisa H Amaral MD, Neal E Seymour MD Tufts University School of Medicine Baystate Medical Center, Springfield, MA Baystate Simulation Center, ACS-accredited Level I Education Institute 2011 APDS Annual Meeting, Boston, MA

2. Objectives Describe our PGY-1 BOOT CAMP Discuss aims and methods of preparatory simulation-based program Describe program experiences and educational outcomes

3. Surgical PGY-1 BOOT CAMP Preparatory simulation-based training implemented at the onset of internship Introduction of cognitive and procedural skills necessary for basic surgical patient problem assessment and management

4. Program Structure Trainees – All PGY-1 residents Teaching faculty – Surgical – Non-surgical – PGY-5 residents – Specialty area clinical nurse educators – Simulation center staff

5. Program Structure Needs assessment – Literature review of orientation practices – Departmental PGY-1 roles & responsibilities – ACGME common program requirements

6. Program Structure Curriculum Design – Weekly 4 hour training sessions over 9 weeks – Objectives-based cognitive skills – Objectives-based procedural skills – Extensive formal assessment and testing

7. Boot Camp Curriculum Areas PROCEDURAL SKILLS Suturing & Knot-tying Airway management Tube thoracostomy Central venous access Essentials of ACLS Ventilator management Invasive monitoring Basic Laparoscopic skills PATIENT CARE SKILLS Volume & Electrolyte disturbances Respiratory distress Arrhythmias & Cardiac arrest Critically ill patient care Shock & Shock states Surgical emergencies Perioperative fever Adverse reactions Trauma patient care Extremes of ag e

8. Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Reading Assignment Testing Procedural Instrument Handling Suturing & Knot Tying CVC Insertion Basic Laparoscopic Skills Chest Tube Airway ACLS Ventilator Management Basic Suturing & Laparoscopic Skills Management Hypovolemia Resuscitation Shock States Adverse Reactions Respiratory Distress Comorbidity Management Cardiopulmonary Arrest Surgical Emergencies Extremes Of Age Testing Reading Assignment

9. Program Structure Assessment – Weeks 1-8 Weekly written pre-tests Procedural skills assessments Patient simulation performance assessments – Week 9 - Final Exam Skills Station Assessments Airway Chest tube CVC insertion Suturing & Knot tying Laparoscopic skills CXR & EKG review Extremes of Age Situational Awareness Written Exam

10. Results July 2007—2010 30 PGY-1 residents BOOT CAMP performance – Written pretests – Skills assessments – Final written examination – Final skills stations assessments

11. Residency Performance Evaluations – Weekly core curriculum quizzes – PGY-1 ABSITE scores – New Innovations TM cognitive evaluations – New Innovations TM technical skills evaluations – OP-Rate TM technical skills evaluations

12. BOOT CAMP Pretest & Final Written Examination Performance Spearman correlation, r=0.56, p=0.0006

13. BOOT CAMP Final Written Examination and ABS In-Training Examination Performance Spearman correlation, r=0.49, p=0.01

14. BOOT CAMP Technical Skills and New Innovations Technical Skills Performance Spearman correlation, r=0.58, p=0.002

15. BOOT CAMP Technical Skills and OP-RATE Technical Skills Performance Spearman correlation, r=0.69, p=0.01

16. We did not find statistically significant correlation in performance comparisons for – BOOT CAMP written examination results & Weekly core curriculum quizzes – BOOT CAMP written examination & New Innovations TM cognitive skills evaluations

17. Conclusions Individual BOOT CAMP performance scores for cognitive and procedural skills assessments correlate with subjective and objective clinical performance evaluations. Concurrent correlation with multiple traditional evaluation methods supports the use of BOOT CAMP performance measures – Needs assessment tools – Adjuncts to cumulative resident evaluation data

18. Conclusions Future Directions – Program evaluation – Curriculum expansion – Curriculum implementation in light of updated duty hours regulations

19. BOOT CAMP: Educational Outcomes After Four Successive Years of Preparatory Simulation-based Training at Onset of Internship Gladys L Fernandez MD, Richard B Wait MD PhD, Nicholas P Coe MD, David W Page MD, Patrick C Lee MD, Lisa Patterson MD, Marisa H Amaral MD, Neal E Seymour MD Tufts University School of Medicine Baystate Medical Center, Springfield, MA Baystate Simulation Center, ACS-accredited Level I Education Institute 2011 APDS Annual Meeting, Boston, MA