Boot Camp Research Articles

Advanced Urology Boot Camp: A Simulation-based Curriculum to Enhance Fourth-year Medical Student Procedural Competency.

Simulation-based medical education continues to gain popularity as the clinical environment requires exemplary patient safety while simultaneously maximizing the learner's educational experience. There is a current lack of urology-focused medical student education curricula in the literature. Here, we present the findings of a didactic and simulation-based medical student advanced "urology boot camp" curriculum, which was designed for learners interested in pursuing careers in urology. Twenty-nine fourth-year urology-dedicated medical students completing their subinternship at our institution during the 2018-2019 academic year participated in an advanced hands-on simulation "boot camp," which taught both simple and advanced Foley catheter placement, manual and continuous bladder irrigation, and diagnostic cystoscopy. Knowledge acquisition was assessed through quizzes administered before and after completing electronic modules, and a post-simulation survey assessing learners' confidence in their knowledge and skill set, as well as their satisfaction with the curriculum. Medical students demonstrated significant gains in knowledge from pre-test (mean 73.7%) to post-test (mean 94.5%, P < .001), which was consistent across each simulation procedure. Participants self-reported significant improvement in confidence with the procedures from before to after the educational intervention (P < .001). Students also found the curriculum to be beneficial to their understanding of the subject matter (P < .001), would recommend this curriculum to other medical students (P < .001), and thought it better prepared them to meet expected ACGME (Accreditation Council for Graduate Medical Education) milestones (P < .001). Findings from our advanced "boot camp" simulation curriculum demonstrated successful gains in knowledge and confidence following learning modules and hands-on simulation, indicating that this type of educational intervention could be beneficial in improving exposure to skills and developing confidence prior to urology internship and junior residency.

Editorial Commentary.

No AccessUrology Practicethe Specialty1 Mar 2023Editorial CommentaryThis article comments on the following:Advanced Urology Boot Camp: A Simulation-based Curriculum to Enhance Fourth-year Medical Student Procedural Competency Alexandra L. Tabakin and Sammy E. Elsamra Alexandra L. TabakinAlexandra L. Tabakin * E-mail Address: [email protected] Division of Female Pelvic Medicine and Reconstructive Surgery, Donald and Barbara Zucker School of Medicine and Hofstra/Northwell, Great Neck, New York More articles by this author and Sammy E. ElsamraSammy E. Elsamra Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000379.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 10(2), p. 201

Developing a mental toughness program for basic military training

ABSTRACT To build a warfighter from the ground up, training should include not only the core competencies required for job performance in the Fleet but also the mental toughness expected to handle the stress, fatigue, and call for sudden action required of all sailors on duty, regardless of occupation. Recruit Training Command (RTC) has embarked on a program to provide explicit training to recruits on the development of toughness in boot camp. This program is multifaceted, including three pilot programs (two all-male pilots, one integrated/mixed gender pilot) for mental skill training. Recruit divisions were assigned to either mental toughness (MT) condition or active control (AC). The MT group received daily, 10-min guided mindfulness exercises, three “just-in-time” trainings in sports psychology skills, and an on-command focusing exercise. Results varied across the three pilots with the exception of on-time graduation rates, which favored the MT condition in every pilot. Taken together, the three MT pilot studies show possible benefits for performance during boot camp with MT practice, and predictable advantages for graduation rates.

Abstract A102: Developing faith-based messaging and materials for colorectal cancer screening: Application of boot camp translation within the African Methodist Episcopal Church

Abstract Introductory sentences: We use boot camp translation (BCT), a validated community based participatory strategy, to elicit input from African Methodist Episcopal (AME) congregants, leadership, and healthcare systems in Atlanta, Georgia to create culturally appropriate and locally relevant colorectal cancer (CRC) faith-based screening messages and materials for AME church communities. Brief description of pertinent experimental procedures: In the United States, CRC is the third-leading cause of cancer death and disproportionately impacts African Americans, highlighting the need for timely screening within this community. African American adults have higher annual rates of new CRC cases and are diagnosed with CRC at younger ages when compared to White adults. Regular CRC screening is pertinent to increasing the chance of early diagnosis and survival, however, African Americans are less likely to get screened for CRC than Whites. Church-based educational programs have been successful in promoting cancer screening, including CRC screening, in various racial and ethnic groups. Churches can serve as key partners in delivering health information as they are among the most trusted institutions within the African American community. As part of a collaboration among the American Cancer Society, the Centers for Disease Control and Prevention, AME churches and Atlanta-based healthcare systems, we will apply BCT to develop and disseminate messaging to promote CRC screening within the AME community. The BCT session aims are twofold: 1) to identify the role of the church in bringing CRC information to the AME community and 2) to define the content and format of effective faith-based CRC messages tailored for the AME community. Summary of new, unpublished data: The BCT workshops will occur in July 2022.Statement of conclusions: We anticipate preliminary findings and materials to be ready by September 2022. Citation Format: Priyanka Gautom, Jamie H. Thompson, Cheryl A. Johnson, Jennifer S. Rivelli, Gloria D. Coronado. Developing faith-based messaging and materials for colorectal cancer screening: Application of boot camp translation within the African Methodist Episcopal Church [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A102.

LEVERAGING THE STRENGTH OF UNIQUE PARTNERS TO IMPROVE GERIATRIC EMERGENCY CARE IN RURAL CRITICAL ACCESS HOSPITALS

Abstract Developing a level 1 accredited geriatric emergency department during the pandemic was challenging. The greater challenge has been to support rural critical access hospitals on their journey of becoming level 2 accredited geriatric emergency departments. This has been accomplished through a novel collaborative approach between the level 1 accredited emergency department, a newly established Geriatric Center of Excellence at Dartmouth-Hitchcock Health and a HRSA funded Geriatric Workforce Enhancement Program. This talk will focus on bringing together system partners and funders who have a history of success through: (a) development, testing and dissemination of tool kits and implementation guides; (b) boot camp training that includes interprofessional team training, QI and specific geriatric content training; (c) implementation support and coaching using data and QI methodology through learning collaboratives; (d) scaling successful models of evidence based geriatric care; (e) expertise in implementation science; (f) expertise in evaluation and (g) disseminating findings to achieve our goals.

UTILIZING BOOT CAMP TRANSLATION TO ENCOURAGE HISPANIC/LATINX PARTICIPATION IN ALZHEIMER’S RESEARCH

Abstract Hispanic/Latinx (H/L) individuals are 50% more likely to develop Alzheimer’s disease (AD), relative to non-Hispanic whites. Despite higher prevalence rates and earlier age of onset, H/L individuals are underrepresented in aging and AD research. The Engaging Communities of Hispanics for Aging Research (ECHAR) Network is an interdisciplinary, multi-site project that aims to address these disparities. ECHAR uses Boot Camp Translation (BCT), a community-based participatory research (CBPR) approach that partners research faculty and medical experts with community stakeholders to translate medical jargon into action-based, locally-relevant messages. Researchers at University of Nevada, Las Vegas recruited 14 community members to participate in an AD-specific BCT. The process was completed between June 2021 through January 2022 to identify: 1) key messages, 2) target audience(s), and 3) dissemination strategies. BCT members identified three messages to reflect community concerns and highlight values: 1) “Amar es saber” (“To love is to know”), which acknowledges the importance of family and addresses cultural norms that may discourage disease conversations; 2) “The community cares. Let’s talk.”; and 3) "Podemos afrontar el Alzheimer juntos." (”We can face Alzheimer’s disease together.”). Target audiences include younger and middle-age adults who may be or become caregivers and local non-profit and community organizations. Members identified social media, community education events, community influencers, and educational products as dissemination strategies. BCT is an effective tool for engaging local communities and exploring Hispanic/Latinx beliefs and attitudes toward AD. It leverages community member expertise to create meaningful, tailored, and culturally-relevant messages that address health disparities and encourage action.

IT Curriculum for Boot Camp: An Iterative Development In Applying OBE In Computer Science Education for Non-Formal Institution

With the development of technology in software design, computer programming is now prevalent in almost every aspect of modern business and daily life. A renewed focus on programming education is attracting workers’ attention and converting skills. In previous research, researchers found difficulties encountered while learning programming languages. In this study, we conduct a case study on Teknokasi startup to develop a curriculum based on customer satisfaction. In this study, data was collected through surveys, which is a qualitative method. The methods used to collect data are interviews and questionnaires. The results of this study indicated three iterations, and further research is required to improve curriculum development. In this iteration, we will use the scrum framework and OBE as a theoretical base. Using input from mentors and students, this study was able to develop the next curriculum and improve programming skills, especially targeted Javascript expertise in a short time frame. Further studies need to be performed to assess this curriculum's effectiveness.

The Impact of Surgical Boot Camp on Medical Student Confidence and Imposter Syndrome

IntroductionTransitioning from medical student to surgical intern is accompanied by increased responsibility, stress, and clinical burden. This environment lends itself to imposter syndrome (IS), a psychological condition grounded in self-doubt causing fear of being discovered as fraud despite adequate abilities. We hypothesized a 2-week surgical boot camp for fourth year medical students would improve confidence in technical skills/knowledge and IS. MethodsThirty medical students matching into surgical specialties completed the boot-camp in February 2020. Presurveys/postsurveys assessed confidence levels using a 1-5 Likert scale regarding 32 technical skills and knowledge points. The Clance Impostor Phenomenon Scale (CIPS) assessed IS, where increasing scores correlate to greater IS. ResultsMedian (interquartile range [IQR]) subject age was 27 y (26, 28), 20 (66.7%) were male, and 21 (70%) were Caucasian. Of the 30 students, 23 (76.7%) had a break in training with a median [IQR] of 2 [1, 3] y outside of medicine. Confidence scores were significantly improved in all five assessment categories (P < 0.05); however, there was no change in CIPS in median [IQR] presurveys versus postsurveys (65.5 [52, 75] versus 64 [52, 75], P = 0.70). Females had higher mean (standard deviation) pre-CIPS than males (68.4 [15.2] versus 61.6 [14.9], P = 0.02). There was no strong correlation between age and CIPS in the presurvey (Spearman Rank Correlation Coefficient [SRCC]: 0.29, P = 0.19) or postsurvey (SRCC: 0.31, P = 0.10). While subjects who worked outside of medicine had a stronger relationship with IS (SRCC: 0.37, P = 0.05), multivariable regression analysis did not reveal any significant differences. ConclusionsWe advocate for surgical boot-camp training courses to improve trainee skill and confidence. As IS is not improved by boot camp, additional research is needed to identify opportunities to improve IS among surgical trainees.

'Us versus them': Asocial identity perspective of internal medicine trainees.

Silos and group boundaries in the clinical workplace can result in interprofessional conflict which can be asource of anxiety for doctors in training. The social identity perspective (SIP) incorporates theories of social identity and self-categorisation, and may provide auseful lens to understand the socialisation and identity development of doctors. This study aimed to determine if and how the SIP may provide insight into intergroup relations as experienced by internal medicine (IM) trainees in Scotland. Interprofessional communication workshops hosted as part of an IM boot camp between August 2020 and March 2021 were audio recorded and transcribed verbatim. Subsequent individual interviews with consenting trainees further explored social identity and intergroup relations. Data analysis employed template analysis and deductive independent coding with the SIP informing the initial coding template and new codes added inductively. Seventeen workshops, involving 100 trainees, and ten subsequent individual interviews were included. Trainees related to the social identity of an IM doctor and to stereotypes within the workplace. They described intergroup tensions resulting from aperception of differing priorities. They experienced outgroup derogation and the impact of role modelling those in their social group during their identity development. The SIP provides auseful lens to understand the social phenomena at play for IM trainees. It confirms the expectation of conflict between specialties and negative perceptions of outgroups. There is aneed to consider the hidden curriculum of socialisation in the workplace during training and the influence of the learning environment on identity development.

The Use of Tropical Fruits for Skills Training in a Neurosurgical Boot Camp

Objective: Neurosurgical boot camps allow trainees to hone practical skills in a risk-free environment, but the models and simulators used are relatively costly. In developing countries like the Philippines, low-cost alternatives have to be devised. The authors aimed to demonstrate the feasibility of using local, readily available, and inexpensive tropical fruits as surrogate models for basic neurosurgical skills training during a neurosurgical boot camp. Methods: Locally available tropical fruits were used to teach basic neurosurgical skills to trainees. Coconut, pomelo, and watermelon were used as models for head clamp application, scalp and dural suturing, and ventriculostomy, respectively. Feedback was obtained from the participants after the boot camp. Results: All eight residents thought that the boot camp was useful in learning new skills, and that the fruit models served their purpose. The trainees favored the fruit models that catered to the skill sets required according to level of training. The use of tropical fruits in the boot camp also provided an informal atmosphere that was conducive to learning. Conclusion: The novel use of tropical fruits as surrogate models in basic neurosurgical skills training was a feasible and affordable alternative in resource-limited settings, although the activity was perceived to be more useful to junior than to senior residents. The informal atmosphere generated by the use of the fruits contributed to an improved learning experience for the trainee. Key words: Teaching, simulation training, surgical skills, low-cost

The QUICK SCREEN in Action: Project, Product, or Platform Case Examples

Assessing innovative technologies and venture opportunities in the biopharma-life science space involves a complicated effort. However, should it be? This question is especially relevant when screening new opportunities. This paper addresses how established firms can quickly and efficiently assess new biomedical-life science ventures of different maturity (development and commercial) levels. Boni’s (2012, 2019) “quick screen” and metaphorical “3 Ps” (project, product, platform) provide a practical framework to examine new biopharma-life science ventures (assets). Boni’s works (2012, 2019) frame these elements. They intend to provide a framework to complement case studies for use separately in a workshop or “boot camp” format. Our present effort includes multiple case studies to provide practical guidance for the framework’s use. Accordingly, this paper extends Boni’s work by examining eight practical cases gathered via a purposeful sample to illustrate the use of the “quick screen” relative to each metaphorical category: project (4), product (2), and platform (2). Data sources included company and market information from company documents, firm websites, peer-review sources, market reports, and business portals. Data were mapped against “quick screen” criteria and categorized as positives, negatives, or uncertainties. Evaluation of the mapped data led to low to medium to high ratings relative to opportunity, monetary, and competitive advantage criteria. Descriptions provide qualitative insights to situate each case example relative to its specific “3 P” category, with six cases subclassified (e.g., moderate-low, low-moderate, high-moderate) when graded. This paper provides four practical contributions: 1) multiple “real world” cases to illustrate the framework, 2) a risk-opportunity-maturity relationship model, 3) scenarios of when or when not to use the “quick screen”, and 4) engagement strategies based on “P” classification as practice contributions. It concludes that Boni’s (2012, 2019) construct provides a useful and efficient tool for examining new biopharma- life science ventures (assets) at differing maturities. Future work should build on these case examples, findings, and contributions while embracing a more-structured case study evaluation methodology to further practice and theory contributions.

In the Printshop / With Young Poets

In the Printshop / With Young Poets Charles Alexander (bio) Why would a poet, good with words, good with words in the world, good with worlds in the words, filled with things to say, imagining ways to say them, and simply loving the way poems, as one enters them, lead the poet to write them—why would a poet want to learn to work with type, layout, paper, print, pages, editing, distribution, etc.? Why would a poet want to make books? Why would a poet want to begin a literary press? I can speak for myself, and will, but that is through a long lens of memory, as I was a poet who began to learn to print and make books almost forty-three years ago. Memory plays tricks, though, so I also spoke to students between two weeks and ten days ago in the printshop at Naropa University in Boulder, Colorado. All of the students there are young poets and fiction writers who choose, during the Summer Writing Program of the Jack Kerouac School of Disembodied Poetics, to spend a week learning various things about the making of books, depending on just who is the faculty member leading them for that week. This summer, from 13 June to 17 June, that faculty member was me, and my group of five young women who named themselves "The Gentlemen of the Press" set small texts of their own, by hand, in type composition sticks, eventually to become small blocks printed onto papers of their choice, in one or more ink colors. My challenge to them, in a week in the SWP that was themed "Oracles & Cyborgs," was to allow the cyborg to dominate, and introduce something non-letterpress to their print, to add or augment or disturb in some way. Some people take letterpress as a bit too precious for my likes, so I wanted them to challenge that, and also learn something new, busy their hands and minds in other ways. Some drew, some sewed something onto their pages, some stamped, some chose other paths, and one simply printed more pages. So, they weren't exactly following my "rules," but I would rather them find their own way any day, around any press. Rather like what we do when we write poems. Know some rules [End Page 174] and suggestions, but value independence, free-thinking, even some risk-taking. Then, after two workshop days (each workshop period being three hours only), they had the task of binding their pages together into an Asian-style side-stitched or "stab" binding, after printing title page and book front and back covers. Ordinarily we would have had four sessions, but Frontier Airlines simply did not fly their flights on time, or, in my case, not at all one night, so I missed (meaning we all missed) the first session. I have never been quite so impressed in such a workshop at what the young poet-printers accomplished, and how hard they worked to accomplish it, in such a short period of time, a time when they also listened to multiple lectures, panels, and poetry readings, including a couple by me; a time when I believe they were also all reading works new to them, and writing new works. My partner calls this week "poet camp," and in some ways it's more like boot camp, but it's also one of my favorite weeks of any year I am asked to teach there, this year being about my seventh time, but as I become one of the elders there, I may be losing count. That tricky memory again. I know that when I began work in bookmaking, several years after I consciously began to know I am a poet, that it felt like an accident. I went to a conference on Charles Olson, and one of the fields in evidence there was that of small-press bookmaking, small books with lovely impressed text and illustration, on fine papers, sewn by hand, by one of the fascinating small presses of the time (this was 1978), Toothpaste Press (squeeze that tube of ink?), founded and worked in all its aspects by Allan Kornblum in West Branch...

Paediatric anaesthesiology education: simulation-based 'attending boot camp' for fellows shows feasibility and value in the early years of attendings' careers.

Established simulation-based 'boot camps' utilise adult learning theory to engage and teach technical and non-technical skills to medical graduates transitioning into residency or fellowship. However, the transition from trainee to the attending role has not been well studied. The primary aim of this study was to design and execute a simulation-based educational day, exposing senior trainees in paediatric anaesthesia to commonly encountered challenges and teaching critical technical skills relevant to their new role. Secondary aims included assessment of its value and relevance in early years of graduated fellows' new careers as attendings. An 'attending boot camp' day comprised the following: two crisis simulations, an otolaryngologist-taught cadaver cricothyroidotomy laboratory, and a difficult conversations workshop. There was a debriefing after each section. Data were collected using end-of-day and early-career e-mail surveys for five consecutive fellow cohorts from 2016 to 2020. Forty fellows participated; overall feedback was positive. The end-of-day surveys revealed planned changes in practice for 89% (25/28) of fellows, and 54% (15/28) highlighted communication skills as 'most beneficial'. Early-career follow-up surveys found 96% (23/24) identified increased confidence in skill acquisition because of the day; 79% (19/24) experienced scenarios in real life similar to those simulated. The qualitative analysis revealed four high-value themes: delegation, leadership, clinical skills, and difficult communication. The transition from senior trainee to attending physician remains under-researched. A tailored simulation-based 'attending boot camp' was feasible and valued and may be useful in bridging this transition. Participants identified leadership practice, life-saving technical skills, and difficult communication practice as valuable and relevant in their early careers.

Synergic Coding System: An Online Coding Platform

Abstract: Online education is presently quite popular. The widespread availability of the internet makes information sharing and acquisition simple and affordable. Many schools now offer online courses in all subject areas. More students are turning to online learning due to its simplicity and ease. Online coding boot camps grew by 177% between 2018 and 2019, according to a private organization that assists consumers in finding the most affordable coding boot camps, based on a market analysis of 79 US and Canadian locations. With the increase in online coding classes and boot camps, there is a more significant demand for tools to assist instructors and students in reaping the valuable benefits from the new methods of learning and giving a lecture. The primary issue with this type of learning is the environment in the coding or programming sector. As building up infrastructure and an environment is critical. Another concern is the interaction between the teacher and student because progress tracking is unavailable in the existing systems.

Boot camps and academia: odd bedfellows for a national collaborative approach to training non-medical cystoscopists

Scottish cystoscopy service provision faces significant challenges in the years ahead driven by COVID-19’s impact on diagnostic waiting times, the development of national treatment centres to expand infrastructure/service delivery, and limited short-term medical capacity to support recovery. These factors have greatly increased demand for the rapid development of a supportive non-medical cystoscopist workforce [1]. There is currently no agreed national approach to non-medical cystoscopy training in Scotland despite clear guidance on competencies from the British Association of Urology Nurses (BAUN). Our proposed solution has been to collaboratively develop and pilot an accelerated learning programme, including a simulation ‘bootcamp’, that pump primes adaptation to the role and clinical training requirements through technical and non-technical skill rehearsal. We invited experts from clinical practice, education, and simulation to form a national short life working group ( Diagram of the national short life working group A unified model for pilot was developed, integrating clinical simulation, theory, and work-based learning (WBL). It focuses on core cystoscopy skills initially, providing the necessary knowledge and ‘hands on’ ability required for independent practice. The process is primed by a two-day ‘cystoscopy bootcamp’ using simulation-based education (SBE). This comprises of a variety of methods including high volume cystoscopy skill rehearsal of increasing realism, progressing to cadaver. Non-technical skills are simulated through bespoke scenarios relevant to the role including obtaining informed consent, team communication, and delivering bad news. Expert discussion and debriefing is interwoven throughout. Formal evaluation is ongoing with early reports of increased preparedness and quicker adaptation to the clinical environment. In addition to the anticipated benefits, bootcamp also established early peer support mechanisms and, through the engagement and networking of diverse faculty, fostered integration with the wider community of practice, and a commitment to building a continually improving, user-informed simulation programme. The method provides a cost-effective collaborative way to explore research, educational models, and the challenges of implementation in real time, through a multi-professional lens. The approach has been crucial to ownership, commitment and acceptance of the programme while fostering integrated cross discipline delivery. 1. Scottish Government Endoscopy and urology diagnostic recovery and renewal plan. 30 Nov 2021 Endoscopy and urology diagnostic: recovery and renewal plan – gov.scot (

Enhanced simulation-based mastery learning for the attainment of procedural skills competence for acute common care stem (ACCS) trainees

A new curriculum for Acute Common Care Stem (ACCS) trainees was introduced in 2021 and included a mandatory requirement to have specific practical assessments performed, known as Direct Observation of Procedural Skills (DOPS). These aimed to provide evidence of competence and enable progression through training. The curriculum change prompted the creation of a novel one-day skills-based course in order to ensure that all the ACCS trainees met the required level of competence. An enhanced simulation-based mastery learning method was used to ensure that trainees have the clinical knowledge to identify when future practical emergency skills are indicated and have the psychomotor skills necessary to perform these procedures safely and efficiently. This study was aimed at exploring the impact of a simulation-based mastery learning (SBML) [1] in a one-day procedural skills course. New curriculum content was reviewed in order to establish the different practical skills required for the second year of ACCS training. Regional trainees were then sent an online survey to ask which specific procedures they would like included on a skills course. There were five procedures requested: chest drain insertion (Seldinger and open), aspiration of air, DC cardioversion, and external cardiac pacing. Meetings with the local training programme director and simulation lead assisted in the formation of the skills day. Faculty were formed by registrars and consultants in Emergency Medicine. Trainees aimed to reach a competence level that would mean they still need in hospital supervision for any future procedures. Eight ACCS trainees attended a one-day skills-based course in May 2022. The course was preceded by multiple online e-learning resources and videos. The SBML day consisted of a demonstration with deliberate practice followed by DOPS assessments using simulation and trainee-focused feedback. Anonymised pre- and post-course questionnaires were completed by all trainees containing questions surrounding their experience and confidence in performing these procedural skills. All trainees achieved the required level of competence needed at their stage in training. Each trainee stated that their confidence levels improved in performing all five procedures after attending the course ( Mean confidence levels in procedures pre- and post-course using Likert scale (1–5) An enhanced SBML method in a one-day course enabled efficient, standardised procedural skills practice and assessment for a group of ACCS trainees. Training, practice, and assessment in necessary curricular competences were achieved together while improving the level of confidence in trainees performing these procedures. 1. Scahill E, Oliver N, Tallentire V, Edgar S, Tiernan J. An enhanced approach to simulation-based mastery learning: optimising the educational impact of a novel, National Postgraduate Medical Boot Camp. Advances in Simulation. 2021;6(1).

Resident Physician “Moonlighting” for On-call in Transfusion Medicine: Educational Impact and Preparedness for Practice

Abstract Introduction/Objective Resident physician moonlighting is controversial and uncommon in Pathology, usually limited to anatomic pathology grossing support. Due to an acute staffing shortage in our department, we offered senior AP/ CP residents in our program a “moonlighting” opportunity involving partnership with attendings to supervise junior residents for transfusion medicine on-call (TMO) . Given the conflicting claims of educational benefit and detriment of moonlighting, we sought to evaluate impact of TMO moonlighting activities on residents' educational experience and preparedness for clinical practice. Methods/Case Report Residents selected for moonlighting TMO were PGY-3/4, “exceeded expectations” on their transfusion medicine rotation and had taken resident TMO. After initial “boot camp” exercises involving common TMO scenarios, they were added to the attending on-call schedule with a fair financial incentive. They were the first resource and provided in-person support for the TMO resident. Attendings were available for consultation via a secure communications platform (phone and text). After one year, residents were surveyed regarding overall experience, sense of graduated responsibility, impact of financial incentive, preparedness for future practice, and impact on day- time service commitment. "Resident In-Service Examination" (RISE) score was used to estimate impact of TMO on medical knowledge. Results (if a Case Study enter NA) NA. Conclusion Four out of the five residents took the survey. All 4 responded “definite” for positive experience, feeling of graduated responsibility and preparedness for practice. Financial incentive was assessed favorably. No resident reported an adverse impact on their daytime service responsibility. The group median score on RISE transfusion medicine 2022 was 75th percentile with median increase in 10 percentile points. As pathology moves towards sub- specialty practice, working fluency in some areas such as TMO remains a necessity for smaller group practices. Our experience (albeit with a small group of residents) suggests that TMO moonlighting activities may better prepare the residents for this unmet need.

EDITORIAL COMMENT

In this article, “Urology Boot Camp: A Pilot Medical Student Curriculum For Common Bedside Urologic Procedures,” the authors developed a novel, urology-specific (catheter placement and irrigation) "boot camp" for third year medical students. The boot camp was very thoughtfully designed to minimize in-person instruction time, and included an online module that students needed to view ahead of time, followed by a single hands-on session. The intervention was incredibly well-received by students, who said they would recommend repeating it for others and reported increased comfort with Foley catheter placement and irrigation. As urologists we have a vested interest in exposing medical students to the most basic and fundamental urologic procedures for multiple reasons; not only can this early exposure pique interest in our fantastic field, but knowledge of basic bladder management can be utilized in every field of medicine. The intervention reported on in this article is simple and reproducible. The logical next step is how it can be scaled to reach more students. There are 192 medical schools in the US (MD and DO), and rather than every institution re-inventing the wheel to develop their own curriculum, this is an opportunity ripe for standardization and facilitation of such skill and educational sessions. The American Urological Association has been, and should continue to be, a driver in these efforts to standardize educational sessions and afford their broad availability. Simulation allows for exposure and repetition of skills in a low-stress and low-risk environment. If cost prohibits model-based simulation of the skills discussed in this article, consideration can be given to low-fidelity simulation of the same skills, as a rudimentary lower urinary tract can certainly be simulated without a costly human model. We applaud the authors for addressing an unmet need in medical education and are encouraged by the interest in empowering the next generation of physicians to gain confidence and competence in basic urologic skills.

Intensive preoperative ostomy education for the radical cystectomy patient.

Patients undergoing radical cystectomy with ileal conduit formation usually receive training on the use of their stoma during their initial hospitalization - while actively recovering from surgery - often with little follow-up or reinforcement. Many of these patients are not equipped to deal with these significant body changes, which can lead to additional clinic visits, stoma-related complications, and decreased patient satisfaction/health-related quality of life (HRQOL). In an effort to improve patient education, we sought to evaluate the feasibility of implementing a preoperative comprehensive stoma education session termed the "stoma bootcamp" for patients scheduled for a radical cystectomy and ileal conduit (RCIC). We tracked patient related outcomes to determine its impact. We performed a longitudinal, quality-improvement feasibility study at the University of Kansas Health System. All patients who were scheduled to undergo a RCIC for bladder cancer were offered enrollment into the study at their preoperative clinic visit. The "stoma boot camp" consisted of a 3-hour group session within 2 weeks of the surgery date. Patients were given a short presentation by residents and advanced practice providers regarding the operation, recovery, and expectations for their post-operative care. Ostomy nurses then demonstrated basic urostomy care - pouching, sizing, emptying - along with trouble-shooting tips for common ostomy problems. Measurements of HRQOL questionnaires were completed at the initial visit, after "boot camp," and at defined time points after surgery for 12 weeks. This included using an ostomy adjustment score. Length of stay, unplanned stoma-related interventions, and re-admissions within 30 days were also tracked. In this initial pilot program, 51 patients participated in the stoma bootcamp. The patients had an average ostomy adjustment score (OAS) of 150.4 (95% CI 142.0, 158.8) at discharge from the hospital, and these high OAS levels persisted throughout the 12 weeks of follow-up data without any significant decline. Short-form 36 (SF-36) scores demonstrated numerical improvements in each individual category at the 6-week mark above baseline. These improvements persisted at the 12-week mark. In this study we were able to establish the feasibility of implementing a preoperative comprehensive stoma education session for patients scheduled for a RCIC. Additionally, we were able to document favorable HRQOL data and improved ostomy adjustment scores surrounding the education session.

AUTHOR REPLY

The reviewer's editorial comment is graciously received and emphasizes many of the same points we wanted to express and execute with our Urology Boot Camp. In organizing this curriculum we aimed to create a pilot medical student simulation that was easily accessible, highly applicable, and reproducible at other institutions. By focusing on common urologic bedside procedures such as foley catheter placement and irrigation, we hoped that not only could these concepts be applied to a broad range of medical specialties that a student could pursue, but they also allotted time and exposure to the incredible field of urology.