Nathan R. Selden, MD, PhD
Campagna Professor and Chair
Department of Neurological Surgery
Oregon Health & Science University
Portland, Oregon
The specialty-wide “boot camp” movement began in neurological surgery. Many local and global forces in graduate medical education (GME) have driven the adoption and spread of boot camps:
- Neurosurgery assumed responsibility for the internship or post-graduate year 1 (PGY1) year from general surgery;
- Duty hours limited the exposure of residents to formative clinical experiences (especially early in training); and
- Public and regulatory pressure focused attention from the inception of residency on patient safety and outcomes.
The neurosurgery PGY1 boot camps were piloted in Portland, Oregon, and Chicago, Illinois in 2009, and then rolled out nationally with the backing and oversight of the Society of Neurological Surgeons (SNS) in 2010.1,2
Some might ask the question, what’s novel about the neurosurgery PGY1 boot camps? Well, the Neurosurgical Boot Camps were the first to:
- Encompass all entering residents in an entire specialty, nationwide. Since 2011, attendance by residents at U.S. residencies regulated by the Accreditation Council for Graduate Medical Education (ACGME) has been 100 percent.
- Coordinate with a curriculum endorsed by our national residency directors’ society, the SNS.
- Link to the national educational outcomes tool, the ACGME Milestones.
- Deliver a systematic, uniform curriculum nationally at multiple centers (6), to save travel time for faculty and residents as well as expense.
The boot camp curriculum centers on some of the essential skills, knowledge and attitudes necessary to learn, succeed and participate safely in high quality neurosurgical patient care during internship. Important aspects of behavioral skills — such as communications and professionalism — as well as technical skills — including placing a ventriculostomy or a lumbar drain — are taught during these sessions. The boot camps use inexpensive but sophisticated model-based simulators to teach manual skills, with intensive, hands-on faculty mentorship.3
The regulatory structure of the boot camp courses is also unique within neurological surgery. The material taught is entirely determined by the SNS Committee on Resident Education (CoRE). Additionally, the boot camps are funded by industry support, through educational grants to the Congress of Neurological Surgeons (or in the case of other courses in the boot camp series, to the American Association of Neurological Surgeons). This arrangement creates a “firewall” between curriculum and funding, which is especially important in the setting of resident education, and has become a best practice for this function.
Most importantly, the boot camps contribute mightily to the culture of learning and safety in neurological surgery. Residents and faculty members separate themselves from the hectic demands of the clinical service at their hospitals, and spend two days concentrating on learning, safety, education, and mentorship.4 The boot camps are a cardinal feature of the neurosurgical training experience, joining other “rights of passage” such as the interview trail, written and oral board examinations and the RUNN Course in Wood’s Hole.
My SNS colleague, Dr. Nicholas Barbaro, who has been involved in teaching the boot camps with me since the very first pilot course in Portland in 2009, recently noted with satisfaction that we will soon graduate the first “boot camp generation” of residents. I am confident their experiences with the boot camps have contributed to their training and also exemplify neurosurgery’s foundational and ongoing commitment to the role of mentorship and training in our specialty. This is just one of many ways that organized neurosurgery continues to lead in GME.
Editor’s Note: During the month of March, we encourage everyone to join the conversation online by using the hashtag #gmemonth.
References:
1. Selden, N.R., Barbaro, N., Origitano, T.C., and Burchiel, K.J. (2011) Fundamental skills for entering neurosurgery residents: Report of a Pacific region ‘Boot Camp’ pilot course, 2009. Neurosurgery, 68(3):759-764. DOI: 10.1227/NEU.0b013e3182077969
2. Selden, NR,* Origitano, TC, Burchiel, KJ, Getch, CC, Anderson, VC, McCartney, S, Abdulrauf, SI, Barrow, DL, Ehni, BL, Grady, MS, Hadjipanayis, CG, Heilman, CB, Popp, AJ, Sawaya, R, Schuster, JM, Wu, JK, and Barbaro, NM (2012) A national fundamentals curriculum for incoming neurosurgery PGY1 residents: The 2010 Society of Neurological Surgeons Boot Camp courses. Neurosurgery, 70(4):971-981. DOI: 10.1097/PCC.0b013e31823f435c
3. Selden, N.R., Origitano, T.C., Hadjipanayis, C., and Byrne, R. (2013) Model based simulation for early neurosurgical learners, Neurosurgery (with accompanying podcast), October 2013, 73:S15-24.
4. Selden, N.R., Anderson, V.C., McCartney, S., Origitano, T.C., Burchiel, K.J., and Barbaro, N.M. (2013) Society of Neurological Surgeons boot camp courses: Knowledge retention and relevance of hands on learning after 6 months of postgraduate year 1 training. Journal of Neurosurgery, April 2013, DOI: 10.3171/2013.3.JNS122114
