Letter to the Editor: Boot camp

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To The Editor: Selden et al.2 should be congratulated for their evaluation of the neurological surgeons' boot camp courses (Selden NR, Anderson VC, McCartney S, et al: Society of Neurological Surgeons boot camp courses: knowledge retention and relevance of hands-on learning after 6 months of postgraduate year 1 training. Clinical article. J Neurosurg [epub ahead of print April 16, 2013. DOI: 10.3171/2013.3.JNS122114]). Course participants demonstrated improved knowledge scores, and learners clearly liked and appreciated the course. However, readers should exercise caution before universally reproducing the methods described; there are still

To The Editor: Selden et al.2 should be congratulated for their evaluation of the neurological surgeons' boot camp courses (Selden NR, Anderson VC, McCartney S, et al: Society of Neurological Surgeons boot camp courses: knowledge retention and relevance of hands-on learning after 6 months of postgraduate year 1 training. Clinical article. J Neurosurg [epub ahead of print April 16, 2013. DOI: 10.3171/2013.3.JNS122114]). Course participants demonstrated improved knowledge scores, and learners clearly liked and appreciated the course. However, readers should exercise caution before universally reproducing the methods described; there are still some unanswered questions about the educational intervention.

First of all, although there was improvement in knowledge, there was no report of improvement in performance among learners at the boot camp. There was no audit of their work, no results of multisource feedback on their behavior, and no direct assessment of their procedural skills by a senior trainee. Doctors are notoriously unreliable at reporting on their own knowledge and skills; only by means of objective methods will we come closer to knowing their actual ability. Perhaps if a follow-up study is planned, some of these outcomes might be measured.

Secondly, the boot camps were a multifaceted intervention, and so it is difficult to say which facet of the boot camp led to the positive outcomes. Perhaps a study in which different groups of students received different interventions would be worthwhile.

Thirdly and lastly, like many medical education interventions, the cost of the boot camps was not evaluated. Even if we assume that the boot camps were effective, it is impossible to say whether or not they were cost-effective. According to Liam Donaldson “in the current, cost-constrained environment, those funding the education of our doctors will no longer tolerate an approach of quality at any cost.”1 Increasingly the providers of medical education will have to thoroughly cost out their interventions and prove that those interventions are not just effective but cost-effective also.

Disclosure

The author reports no conflict of interest.

References

  • 1

    Donaldson LForeword. Walsh K: Cost Effectiveness in Medical Education Oxon, UKRadcliffe Publishing2010. viiviii

  • 2

    Selden NRAnderson VCMcCartney SOrigitano TCBurchiel KJBarbaro NM: Society of Neurological Surgeons boot camp courses: knowledge retention and relevance of hands-on learning after 6 months of postgraduate year 1 training. Clinical article. J Neurosurg [epub ahead of print April 16 2013. DOI: 10.3171/2013.3.JNS122114]

Response

My coauthors and I thank Dr. Walsh for his thoughtful comments. Furthermore, we agree fully with his expressed priorities for further development of educational science related to the neurosurgical boot camp courses. As mentioned in our discussion, the principal current activity of the course curriculum committee is to introduce validated assessments of course hands-on skills. Dr. Walsh is also correct that we did not control for or independently vary which of the multifaceted course interventions may have contributed to the markedly positive educational outcomes. As previously described,2 these courses were introduced in 2010 after all US neurosurgical residencies incorporated the postgraduate Year 1 in order to replace introductory curricular material previously provided by general surgery training programs. Like the vast majority of medicine and surgery we practice, very little medical and surgical education is validated in any way. Although additional validation is a laudable goal, which we continue to pursue, we do not feel that it should stand in the way of efficiently introducing carefully designed and purposed curricular material to fill obvious gaps in training. Furthermore, the face validity of trainees creating their first bur holes in a beef scapula rather than the cranium of a living patient, for example, is almost inescapable.

A cooperative group of educators working under the supervision of the neurosurgical program directors' organization, the Society of Neurological Surgeons, designed and implemented the boot camp courses. The courses were piloted and refined before national adoption.1 They continue to undergo iterative curriculum improvement based on trainee and faculty input.1 The unique aspect of the neurosurgical boot camp effort is its introduction of a uniform preparatory curriculum for all Accreditation Council for Graduate Medical Education (ACGME)–accredited training programs in a major specialty. All available outcome parameters to date support the value of these courses and provide direction for the further important investigation of their educational effectiveness and cost-effectiveness.

References

  • 1

    Selden NRBarbaro NOrigitano TCBurchiel KJ: Fundamental skills for entering neurosurgery residents: report of a Pacific region “boot camp” pilot course, 2009. Neurosurgery 68:7597642011

  • 2

    Selden NROrigitano TCBurchiel KJGetch CCAnderson VCMcCartney S: A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery 70:9719812012

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Article Information

Please include this information when citing this paper: published online June 28, 2013; DOI: 10.3171/2013.4.JNS13813.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Donaldson LForeword. Walsh K: Cost Effectiveness in Medical Education Oxon, UKRadcliffe Publishing2010. viiviii

2

Selden NRAnderson VCMcCartney SOrigitano TCBurchiel KJBarbaro NM: Society of Neurological Surgeons boot camp courses: knowledge retention and relevance of hands-on learning after 6 months of postgraduate year 1 training. Clinical article. J Neurosurg [epub ahead of print April 16 2013. DOI: 10.3171/2013.3.JNS122114]

1

Selden NRBarbaro NOrigitano TCBurchiel KJ: Fundamental skills for entering neurosurgery residents: report of a Pacific region “boot camp” pilot course, 2009. Neurosurgery 68:7597642011

2

Selden NROrigitano TCBurchiel KJGetch CCAnderson VCMcCartney S: A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery 70:9719812012

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