Abstract
There has been a widespread adoption of training programs or “boot-camps” targeting new surgical residents prior to entrance to the hospital environment. A plethora of studies have shown positive reactions to implementations of “boot camps”. Reaction surveys, however, lack the ability to provide a deeper level of understanding into how and why “boot camps” are seen as effective. The purpose of this study was to develop a rich perspective on the role “boot camps” are perceived to play in resident education.
A constructivist approach to qualitative grounded theory methodology, employing iterative semi-structured, in-person, interviews was used to explore the construct of a “boot camp” through the eyes of key stakeholders, including junior surgical residents (n=10), senior surgical residents (n=5), and faculty members (n=5) at a major academic centre. Interviews were coded and analysed thematically using NVIVO software. Three members of the research team coded data independently and compared themes until consensus was reached. A method of constant comparative analysis was utilised throughout the iterative process. Emerging themes were revisited with stakeholders as a measure of rigor. Axial coding of themes was used to discover the overlying purposes embedded in the “boot camp” construct.
The overarching themes resonating from participants were ‘anxiety reduction’, ‘cognitive unloading’ and ‘practical logistics’. Resident anxiety was ameliorated through subthemes of ‘social inclusion’, ‘group formation’, ‘confidence building’ and ‘formalisation of expectations’. A resident commented “the nuances of how things work is more stressful than the actual job.” Residents bonded together to create personal and group identities, “forming the identity of who we are as a group”, that shaped ongoing learning throughout training, “right from the beginning we would be able to call on each other.” Junior residents found themselves cognitively unloaded for higher level learning through ‘expectation setting’ and ‘formalised basic skills’; “I knew how the equipment was going to fit together, it allowed me to focus more on what was happening from the operative perspective.” Stakeholders highlighted the importance of positioning “boot camp” at the beginning of residency training, as it directly influenced the point of transition. This highlights the strength of the “boot camp” construct at targeting the challenges associated with discrete moments of transition in the advancement in practice.
While surgical preparatory “boot camps” were initially born out of a competency-based framework focused on technical skill development, our findings demonstrate that the benefits outweigh simple improvement in technical ability. The formation of a learner group identity has downstream effects on resident perceptions of anxiety and confidence, while priming for higher-level learning. “Boot camp” then, is re-imagined as an experience of social professional enculturation.
