"Boot Camp" for Orthopedic Interns Shifted to Virtual Platform During COVID-19

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Since 2013, the Department of Orthopaedic Surgery at Massachusetts General Hospital has run a one-month "boot camp" for PGY1 residents that focuses on boosting knowledge and skills training. When COVID-19 disrupted work schedules and made physical gathering unsafe, the department shifted to a virtual program. The program was discussed in a recent article in the Journal of the American Academy of Orthopaedic Surgeons, first authored by Abhiram R. Bhashyam, MD, PhD, former orthopaedic surgery resident, and a colleague to describe the asynchronous learning platform and explain why it's expected to continue beyond the pandemic.

Christopher Bono, MD, executive vice chair of Orthopaedic Surgery and associate director of the Harvard Combined Orthopaedic Residency Program, was a participant, and describes what the program was like.

"Trainees are a smart, vibrant and creative group," says Dr. Bono. "Our virtual boot camp was heavily dependent on the drive of one of our star residents who graduated last year. This program was a wonderful intermingling of low and high tech."

Course Structure

During the month, PGY1 residents worked full time in the boot camp unless redeployed to another service or on weekend call. A syllabus was provided one month in advance and included goals/objectives, descriptions of techniques/procedures and suggested readings and videos.

"The process of setting up this program involved a well-thought plan of translating the components of "live" boot camp into a virtual setting," says Dr. Bono. "The didactic lectures were the easiest to set up. This simply required asking the faculty lecturers to deliver their talks virtually via Zoom."

The course combined lectures and take-home kits for learning surgical skills. The latter contained equipment purchased at local hardware stores or online and was provided one week in advance.

"The technical modules took a bit more creativity. Normally, boot camp would be conducted at a surgical simulation lab. This simulates an actual operating room environment with surgical instruments, lights and simulated tissues," says Dr. Bono. "What the team did here is to evaluate the basic surgical skills of a young, budding orthopedic surgeon and determine how those basic core skills could be practiced at home using easily procured supplies. And then, learning sessions were developed to guide the residents through the various modules."

Knowledge Training

Lectures by faculty or senior residents were delivered using videoconferencing software. Lecturers teaching surgical procedures were encouraged to "walk through" publicly available videos and comment on each case decision by decision and maneuver by maneuver.

The video conferences were recorded and uploaded to a central repository for viewing by any resident in the program.

Skills Training

The 11 skills modules were designed to be completed at home. The article contains brief descriptions of each module and lists the contents of the take-home kits.

During scheduled video conferences, instructors demonstrated specific skills. These, too, were recorded so residents could complete skills exercises asynchronously. Senior residents conducted video conferences with PGY1 residents at a coordinated time to observe their technique and provide informal feedback.

Learner Satisfaction

All 12 residents who responded to a survey said they were satisfied with the course, the modular format and the take-home kits. All reported that boot camp improved their knowledge base and surgical skills, and all but one thought it improved their preparedness for the operating room. Three respondents requested more opportunities for assessment.

Tips for Success

Dr. Bono says, "While we all miss in person learning opportunities, the push of necessity to develop virtual learning opportunities has actually broken down barriers that seemed such obstacles before. Prior to COVID, we experimented with having a broadcast of lectures from one institution to another; now it is commonplace. We would have shuddered to think to use a platform like Skype or Zoom for a meeting: now it is the standard and allows more people to attend than previously."

Other tips for success that emerged from the program included:

• Define expectations for participation and set a daily schedule
• Encourage faculty to call on specific learners and wait longer than usual for an answer, since learners will often have their microphones muted
• For lectures, encourage faculty to split their screen between their slideshow and a gallery view of learners, to simulate a classroom and use the whiteboard feature to demonstrate concepts
• Using two cameras or devices is helpful for teaching a skill (e.g., focus a smartphone closely on the equipment and use a computer to interact with learners)
• When asking learners to demonstrate their skills, use electronic breakout rooms for small-group sessions and coach learners on how to position their camera so evaluators can visualize their technique
• At least one evaluator should have all the same equipment as learners, in case it's necessary to demonstrate the skill

The Way Forward

The cost per resident for the course was $1,700, markedly lower than in previous years because there was no use of assistants, fluoroscopy or animal/cadaver models. 80% of the cost was a one-time investment, and yearly costs to replenish supplies are estimated at $343 per resident. The savings may make virtual programs appealing to departments with fewer resources, both internationally and in the U.S.

Beyond the one-month intensive course, the modules will be available for the education of residents throughout the year. That will allow repetitive psychomotor training in a risk-free environment.

"We have learned that having a home kit that everyone receives can allow the residents to learn even beyond the didactic session," says Dr. Bono. "This is something that likely will remain beyond the COVID restrictions."

Learn more about the Department of Orthopaedic Surgery at Mass General

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