“Boot camps,” a new paradigm for helping medical students and interns prepare for neurosurgical sub-internships, allow participants to sharpen their technical skills by working on animal or cadaveric specimens.
Garth Rees Cosgrove, MD, director of Epilepsy and Functional Neurosurgery in the Department of Neurosurgery at Brigham and Women’s Hospital, Michael A. Mooney, MD, director of Clinical Care Redesign in the Department, and colleagues recently organized a pilot in-person cadaveric workshop for medical students. It included hands-on teaching of craniotomy-related skills by neurosurgery faculty and residents. In World Neurosurgery, the team reports on the students’ response and the operative and procedural tasks the boot camp’s leaders consider important for neurosurgical sub-internships.
Description of the Workshop
Sixteen medical students at the Brigham attended the workshop: six first-year students, eight second-year students, one fifth-year student, and one PhD candidate. The session was organized into five parts to teach skills relevant to a frontal or occipital craniotomy for a subdural hematoma:
- Head pinning and patient positioning
- Surface anatomy, incision, and retraction
- Performing a frontal or parietal craniotomy
- Dural opening, review of cerebral surface anatomy, and dural closure
- Closure of the skin and galea with sutures
Response to the Workshop
Surveys sent before and after the workshop quantified students’ interest in and perceptions of neurosurgery, self-assessments of their skills, and opinions about the relevance of the training to neurosurgical clinical rotations and sub-internships.
After the workshop, students reported increases in:
- All subjective skill metrics
- Understanding of high-speed drill use (P<0.001)
- Interest in neurosurgery as a profession
- Comfort in reaching out to neurosurgical attending physicians and residents
- The perception that peer mentorship is useful in considering whether to specialize in neurosurgery (P<0.05)
Two weeks before the workshop, the trainers (12 residents and 11 attending neurosurgeons) were surveyed about which skills should be taught to prospective sub-interns. Their responses were:
- Interpretation of neuroimaging
- Efficient and thoughtful patient care
- Conceptual knowledge
- Proactive attitude
- Proficiency with minor procedures: (re)programming shunts, shunt taps, lumbar drains, lumbar punctures, arterial lines, stapling/suturing skin, and one-handed knot tying
Concordance of Students and Trainers
The 16 students were surveyed before the workshop about the importance of specified neurosurgical tasks for rotations and sub-internships. They consistently ranked every queried task as very important, presumably because they lacked knowledge about what tasks are truly important.
Medical students, residents, and attendings did agree that burr-hole placement, bone relating, and galea and skin closure are of high importance for sub-interns.
The mismatch in perceptions between medical students and neurosurgeons suggests expectations for students need to be better communicated. Boot camps organized by neurosurgery departments or medical school interest groups are potential ways to set those expectations.
This study showed that boot camps facilitated student learning, engagement between students and the department, and enhanced students’ technical skills.