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Identification of Performance Outliers Early in Residency - Boot Camp Performance Results
*Marisa H Amaral, *Gladys L. Fernandez, David W. Page, Nicholas P. Coe, Richard B. Wait, Neal E. Seymour
Baystate Medical Center, Springfield, MA

Objective: A 9-week preparatory skills course for General Surgery residents shown to be predictive of subsequent educational and clinical performance can also predict underperformance and success in progression through residency.
Design: Retrospective review of training data
Setting: General Surgery residency, Baystate Medical Center, Springfield, MA
Participants: Post-graduate year (PGY)-1 General Surgery residents, 2007-2010 (n=30)
Interventions: At the start of each academic year, all PGY-1 residents underwent a 9-week preparatory course (Boot Camp) in cognitive and procedural skills areas related to fundamentals of surgical care. Skills were assessed with written tests and task-specific instruments. Residents were followed to determine successful progression through or completion of residency training.
Main Outcome Measures: Scores were expressed as mean percent of best possible score. Performance scores more than one standard deviation (SD) below the mean were identified. Outcome measures included completion of surgical training, progression from preliminary to categorical position, and avoidance of underperformance on post-Boot Camp assessments.
Results: Boot Camp scores identified 9 underperforming residents of 30 total (30%). All of these were in preliminary positions. All had performance problems identified on post-Boot Camp measures. 6 had received foreign undergraduate medical training. No Boot Camp underperformers completed training in the program and 2 did not complete the preliminary year. 4 preliminary and 17 categorical residents performed within 1 SD of mean, and had adequate post-Boot Camp assessments. 1 of these preliminary residents received a categorical PGY-3 position in the program.
Conclusions: Boot Camp performance can be used as an effective needs assessment tool that predicts underperformance later in residency. Strategies to use this information to benefit trainees should be a high priority.

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