implementation of a stage-specific resident bootcamp: how ... · moazed f, cohen er, furiasse...

Implementation of a Stage-Specific Resident Bootcamp:

How to Hit the Ground Running

Drs. A. Hadjinicolaou (PGY-4), K. Kaspy (PGY-3), M. Dandavino, E. Ruano-Cea

Montreal Children’s Hospital

McGill University

Conflicts of interest

None to declare

Introduction Conclusion Background Methods Discussion

• Background

• Methods

• Lessons Learnt

• Conclusion/Next steps

Outline

Introduction Conclusion Methods Discussion Background

What are Bootcamps?

“Focused courses designed to enhance learning, orientation, and preparation for learners entering a

new clinical role.”

Blackmore, 2014


Why a Bootcamp in our Pediatrics Program?

Goal: Optimally prepare residents to new roles and responsibilities at

key transition periods of training.

Incoming Junior Resident

Nightfloat Senior

Ward Senior

METHODS

Introduction Conclusion Discussion Background Methods

Framework: Kern’s 6 Steps for Curriculum Development

Kern et al (1998)


General Needs Assessment

Blackmore (2014)

Curriculum

Most often: • Surgical / Procedural • Target entry level • Not stage-specific

Outcomes

• Focus on simulation-based sessions

• Studies looked at improvement in: – clinical skills – knowledge acquisition – perceived confidence


Targeted Needs Assessment

Content of 2nd Iteration

Informal Focus

Groups

Feedback from 1st iteration

Surveys • Key transition periods • “Must know” topics • Knowledge gap • Sources of “transition stress” • “Wish list”


Identification of key transition periods

Clinical activities

Session-specific Objectives

Goals and Objectives

Curricular Alignment Goal: Optimally prepare residents to new roles and

responsibilities at key transition periods of training.

Educational strategies: Final curriculum content

PGY-1 Bootcamp “Incoming junior

resident” Handover, Patient Safety

V-Sign

Documentation

Communication

CXR, ECG

Newborn Exam

PALS-like Cases Technical Skills

(LP, airway, wounds, lines)

PGY-2 Bootcamp “Nightfloat senior”

Overview Nightfloat Senior

Morning Handover

Hematology-Oncology

Difficult Psychosocial Situations

PICU cases

End of Life Care

Patients with Medical Complexities

Challenging Conversations

PGY-3 Bootcamp “Ward senior”

Overview Ward Senior

Multi-Disciplinary Meetings

Bedside Rounds

Discharges

End of Life Care

Patients with Medical Complexities

Challenging Conversations


Educational Strategies: Novel Aspects

1. Incorporation of Mastery Learning principles Clear standards (checklists) Assessment Component



2. Residents as Coaches



3. Multi-Disciplinary Teaching


Implementation

Impact on Clinical Service Logistical Support Teaching Manpower


Program Evaluation

• Self-administered survey • Bootcamp Committee debrief

Immediately post-Bootcamp

• Self-administered survey • Informal focus Groups • Bootcamp Committee debrief

6 months post-Bootcamp


Program Evaluation: Conclusions

Overall well received by residents • Most sessions rated >6.0 out of 7 • Residents reported feeling better prepared and improved self-efficacy

before vs. after

Knowledge Confidence Preparedness

PrePost

Chart1

KnowledgeKnowledge

ConfidenceConfidence

PreparednessPreparedness

Pre

Post

3.84

6.12

3.62

5.9

3.86

5.83

Sheet1

PrePost

Knowledge3.846.12

Confidence3.625.9

Preparedness3.865.83

To update the chart, enter data into this table. The data is automatically saved in the chart.


STRENGTHS AREAS TO IMPROVE

- General satisfaction - Increase in self-efficacy

- Content recommendations - Resources

Lessons learnt

• More Deliberate Practice • More Residents as Teachers

Program Evaluation: Conclusions


Team-Building: Enhancing the Learning

Environment

Introduction Background Methods Discussion Conclusion

Conclusions

• A stage-specific bootcamp is a highly relevant and educationally-congruent strategy that can facilitate transitions to new clinical responsibilities.

• Our experience could help postgraduate programs enhance

their curricular alignment with CBD and CBME.


Future Steps : Bootcamp 2019-2020

• Formalized presence of residents as teachers • Enhance Multi-Disciplinary aspect Teachers

• Increase opportunities for Deliberate Practice • Enhance integration of Mastery Learning principles • Target sessions towards Royal College EPAs

Teaching Strategies

• Formalize the assessment of performance in clinical practice Assessment


A Special Thank You to:

• All those who contributed to the brainstorming, content creation, session development and delivery of the Bootcamp

• All the trainees who attended the Bootcamp • General Pediatrics Residency Program – Dr. Robert Sternszus and Dr. Olivia Tse • Department of Pediatrics – Dr. Michael Shevell • Division of General Pediatrics – Dr. Geoffrey Dougherty • The Bootcamp Committee – Dr. Elisa Ruano, Kimberley Kaspy, Amna Al

Khuzaei

QUESTIONS? THANK YOU FOR LISTENING!


1. Blackmore C, Austin J, Lopushinsky SR, Donnon T. Effects of Postgraduate Medical Education "Boot Camps" on Clinical Skills, Knowledge, and Confidence: A Meta-Analysis. J Grad Med Educ. 2014 Dec;6(4):643-52. doi: 10.4300/JGME-D-13-00373.1.

2. Moazed F, Cohen ER, Furiasse N, Singer B, Corbridge TC, McGaghie WC, Wayne DB. Retention of critical care skills after simulation-based mastery learning. J Grad Med Educ. 2013 Sep;5(3):458-63. doi: 10.4300/JGME-D-13-00033.1.

3. Castro D, Tcharmtchi MH, Thammasitboon S2. A Practical Application of Educational Theories in Developing a Boot Camp Program for Pediatric Critical Care Fellows. Acad Pediatr. 2016 Nov - Dec;16(8):707-711. doi: 10.1016/j.acap.2016.08.007.

4. Cohen ER1, Barsuk JH, Moazed F, Caprio T, Didwania A, McGaghie WC, Wayne DB. Making July safer: simulation-based mastery learning during intern boot camp. Acad Med. 2013 Feb;88(2):233-9. doi: 10.1097/ACM.0b013e31827bfc0a.

5. Winn AS, Marcus CH, Williams K, Smith GC, Gorbounova I, Sectish TC, Landrigan CP. Development, Implementation, and Assessment of theIntensive Clinical Orientation for Residents (ICOR) Curriculum: A Pilot Intervention to Improve Intern Clinical Preparedness. ACADEMIC PEDIATRICS 2018;18:140–144

Key References

https://www.ncbi.nlm.nih.gov/pubmed/?term=Blackmore%20C%5BAuthor%5D&cauthor=true&cauthor_uid=26140112https://www.ncbi.nlm.nih.gov/pubmed/?term=Austin%20J%5BAuthor%5D&cauthor=true&cauthor_uid=26140112https://www.ncbi.nlm.nih.gov/pubmed/?term=Lopushinsky%20SR%5BAuthor%5D&cauthor=true&cauthor_uid=26140112https://www.ncbi.nlm.nih.gov/pubmed/?term=Donnon%20T%5BAuthor%5D&cauthor=true&cauthor_uid=26140112https://www.ncbi.nlm.nih.gov/pubmed/26140112https://www.ncbi.nlm.nih.gov/pubmed/?term=Moazed%20F%5BAuthor%5D&cauthor=true&cauthor_uid=24404310https://www.ncbi.nlm.nih.gov/pubmed/?term=Cohen%20ER%5BAuthor%5D&cauthor=true&cauthor_uid=24404310https://www.ncbi.nlm.nih.gov/pubmed/?term=Furiasse%20N%5BAuthor%5D&cauthor=true&cauthor_uid=24404310https://www.ncbi.nlm.nih.gov/pubmed/?term=Singer%20B%5BAuthor%5D&cauthor=true&cauthor_uid=24404310https://www.ncbi.nlm.nih.gov/pubmed/?term=Corbridge%20TC%5BAuthor%5D&cauthor=true&cauthor_uid=24404310https://www.ncbi.nlm.nih.gov/pubmed/?term=McGaghie%20WC%5BAuthor%5D&cauthor=true&cauthor_uid=24404310https://www.ncbi.nlm.nih.gov/pubmed/?term=Wayne%20DB%5BAuthor%5D&cauthor=true&cauthor_uid=24404310https://www.ncbi.nlm.nih.gov/pubmed/24404310https://www.ncbi.nlm.nih.gov/pubmed/?term=Castro%20D%5BAuthor%5D&cauthor=true&cauthor_uid=27772694https://www.ncbi.nlm.nih.gov/pubmed/?term=Tcharmtchi%20MH%5BAuthor%5D&cauthor=true&cauthor_uid=27772694https://www.ncbi.nlm.nih.gov/pubmed/?term=Thammasitboon%20S%5BAuthor%5D&cauthor=true&cauthor_uid=27772694https://www.ncbi.nlm.nih.gov/pubmed/27772694

Additional Slides


• Consultation with local experts – Medical Education – Patient Safety – Simulation – Quality Improvement

Educational Strategies

Content: ∗ Communication ∗ Systems-based practice ∗ High-Yield Clinical Skills ∗ Procedural/Technical Skills ∗ Physical Exam Skills


• Incoming junior resident PGY-1

• Nightfloat senior- inpatient ward PGY-2

• Senior in-patient wards PGY-3

Key Transition Periods


6. Program Evaluation: Surveys

2. Suggestions & Comments

5-point Likert scale Strongly disagree

1

Disagree

2

Neutral

3

Agree

4

Strongly agree

5

1. Components Learning environment Objectives Content Organization Instructors (preparation, communication, etc.) Overall session Baseline knowledge prior / after

Sense of preparation prior / after

Confidence prior / after

Implementation of a �Stage-Specific Resident Bootcamp: �How to Hit the Ground RunningConflicts of interestOutlineWhat are Bootcamps?Why a Bootcamp in our Pediatrics Program?MethodsFramework: �Kern’s 6 Steps for Curriculum DevelopmentGeneral Needs AssessmentTargeted Needs Assessment Slide Number 10Educational strategies:�Final curriculum contentEducational Strategies:� Novel AspectsEducational Strategies:� Novel AspectsEducational Strategies:� Novel AspectsImplementationProgram EvaluationProgram Evaluation: ConclusionsSlide Number 18Team-Building:�Enhancing the Learning Environment�ConclusionsFuture Steps : Bootcamp 2019-2020A Special Thank You to: Questions?�Thank you for listening!Key References Additional SlidesEducational StrategiesKey Transition Periods6. Program Evaluation: Surveys

implementation of a stage-specific resident bootcamp: how ... · moazed f, cohen er, furiasse...

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