The impact of medical school boot camp curricula and resident autonomy scoring on technical skills performance in general surgery residents

Abstract

PurposeFirst-year general surgery trainees may have reduced technical skills due to limited experiences before starting residency. Medical school boot camps (BC) strive to improve technical skills performance but may have limited impact. Determination of autonomy is one alternative method that could potentially be predictive of technical skills performance. Autonomy occurs when actions are regulated by self and intrinsic motivation rather than external factors. We evaluated both the impact of external structured curricula, such as medical school BCs, in addition to a novel assessment of autonomy, as an intrinsic marker, to determine factors that may influence technical skills performance of incoming general surgery interns.MethodsA 15-item questionnaire about BC experiences was completed by PGY-1 surgery residents from 2016 to 2021 during residency orientation. During orientation, resident technical skills were rated using a modified, validated Objective Structured Assessment of Technical Skills form. Three surgeons, blinded to BC experiences, scored the outcomes of suturing, knot tying, and quality/overall performance of those skills. The 15-question Weinstein self-scoring autonomy survey with a structure of three domains (authorship, self-interest/insight, susceptibility to control) was administered in June 2020 and 2021. Independent t-test analysis compared means across groups. Pearson correlations established bivariate associate strength across measures and multivariate linear regression predicted overall performance from autonomy items.ResultsEighty-seven residents completed the BC questionnaire, with 56.3% (49/87) reporting participation in a BC. Independent t-tests reported no significant differences in suturing, knot-tying, overall performance, quality, and the autonomy domains between the BC and no BC cohorts. The autonomy survey (α = 0.77) was completed by 30 residents. There were significant correlations between authorship and overall skills performance (r = 0.40, p = 0.028), quality (r = 0.43, p = 0.017), and knot-tying (r = 0.36, p = 0.049). Linear regression modeling reported five autonomy items that predicted overall performance (R2 = 0.75, p < 0.001): I strongly identify with things that I do (β = 0.60); I do things in order to avoid feeling badly about myself (β = 0.48); my decisions are steadily informed by things I want or care about (β = 0.33); I often pressure myself (β = – 0.26); and, I am deeply curious when I react with fear or anxiety to events in my life (β = − 0.64).ConclusionsBC participation had no impact on technical skills performance or autonomy measured during intern orientation. However, the authorship domain of learner autonomy was significantly associated with overall skills performance, quality, and knot-tying. Regression modeling reported greater detail into predictive elements of autonomy on overall performance. Utilization of the autonomy survey as a predictive tool for technical skills performance merits further study.