Simulation-based education: Understanding the sociocultural complexity of a surgical training “Boot Camp”

Jennifer Cleland (Corresponding Author), Kenneth G. Walker, Michael Gale, Laura G. Nicol

Research output: Contribution to journalArticle

12 Citations (Scopus)
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Abstract

Introduction
The focus of simulation-based education (SBE) research has been limited to outcome and effectiveness studies. The influence of social and cultural influences in SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical Boot Camp (BC).
Methods
A rapid ethnographic study, employing the theoretical lenses of complexity and activity theory, and Bourdieu’s concept of “capital” to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with Faculty (n=10, including Faculty lead, session leads and junior faculty) and participants (n=19 core surgical trainees/early-stage residents).
Results
Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytic themes. First, the complexity of the surgical training system and wider healthcare education context, and how this influenced the development of BC. Second, participants’ views of BC as a vehicle not just for learning skills but for gaining “insider information” on how best to progress in surgical training. Finally, the explicit aim of Faculty to use Scottish Surgical Bootcamp (SSBC) to welcome trainees/residents into the world of surgery, and how this occurred.
Discussion
To the best of our knowledge, this is the first empirical study of a surgical BC which takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that BC is as much about social and cultural processes as it is individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research.
Original languageEnglish
Pages (from-to)829-841
Number of pages13
JournalMedical Education
Volume50
Issue number8
Early online date11 Jul 2016
DOIs
Publication statusPublished - Aug 2016

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Simulation-based education : Understanding the sociocultural complexity of a surgical training “Boot Camp”. / Cleland, Jennifer (Corresponding Author); Walker, Kenneth G.; Gale, Michael; Nicol, Laura G.

In: Medical Education, Vol. 50, No. 8, 08.2016, p. 829-841.

Research output: Contribution to journalArticle

Cleland, Jennifer ; Walker, Kenneth G. ; Gale, Michael ; Nicol, Laura G. / Simulation-based education : Understanding the sociocultural complexity of a surgical training “Boot Camp”. In: Medical Education. 2016 ; Vol. 50, No. 8. pp. 829-841.
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abstract = "Introduction The focus of simulation-based education (SBE) research has been limited to outcome and effectiveness studies. The influence of social and cultural influences in SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical Boot Camp (BC).MethodsA rapid ethnographic study, employing the theoretical lenses of complexity and activity theory, and Bourdieu’s concept of “capital” to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with Faculty (n=10, including Faculty lead, session leads and junior faculty) and participants (n=19 core surgical trainees/early-stage residents). Results Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytic themes. First, the complexity of the surgical training system and wider healthcare education context, and how this influenced the development of BC. Second, participants’ views of BC as a vehicle not just for learning skills but for gaining “insider information” on how best to progress in surgical training. Finally, the explicit aim of Faculty to use Scottish Surgical Bootcamp (SSBC) to welcome trainees/residents into the world of surgery, and how this occurred.Discussion To the best of our knowledge, this is the first empirical study of a surgical BC which takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that BC is as much about social and cultural processes as it is individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research.",
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note = "Acknowledgements We acknowledge, with thanks the contributions, of the following people who co-designed Boot Camp: Angus JM Watson (Highland Surgical Research Unit, NHSH & UoS), Morag E Hogg (NHSH Raigmore Hospital) and Ailsa Armstrong (NHSH). We also thank Angus JM Watson and Morag E Hogg for helping with the preparation of the funding application which supported this work. Funding Our thanks to the Clinical Skills Managed Educational Network (CSMEN) of Scotland for funding this research.",
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N1 - Acknowledgements We acknowledge, with thanks the contributions, of the following people who co-designed Boot Camp: Angus JM Watson (Highland Surgical Research Unit, NHSH & UoS), Morag E Hogg (NHSH Raigmore Hospital) and Ailsa Armstrong (NHSH). We also thank Angus JM Watson and Morag E Hogg for helping with the preparation of the funding application which supported this work. Funding Our thanks to the Clinical Skills Managed Educational Network (CSMEN) of Scotland for funding this research.

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N2 - Introduction The focus of simulation-based education (SBE) research has been limited to outcome and effectiveness studies. The influence of social and cultural influences in SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical Boot Camp (BC).MethodsA rapid ethnographic study, employing the theoretical lenses of complexity and activity theory, and Bourdieu’s concept of “capital” to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with Faculty (n=10, including Faculty lead, session leads and junior faculty) and participants (n=19 core surgical trainees/early-stage residents). Results Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytic themes. First, the complexity of the surgical training system and wider healthcare education context, and how this influenced the development of BC. Second, participants’ views of BC as a vehicle not just for learning skills but for gaining “insider information” on how best to progress in surgical training. Finally, the explicit aim of Faculty to use Scottish Surgical Bootcamp (SSBC) to welcome trainees/residents into the world of surgery, and how this occurred.Discussion To the best of our knowledge, this is the first empirical study of a surgical BC which takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that BC is as much about social and cultural processes as it is individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research.

AB - Introduction The focus of simulation-based education (SBE) research has been limited to outcome and effectiveness studies. The influence of social and cultural influences in SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical Boot Camp (BC).MethodsA rapid ethnographic study, employing the theoretical lenses of complexity and activity theory, and Bourdieu’s concept of “capital” to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with Faculty (n=10, including Faculty lead, session leads and junior faculty) and participants (n=19 core surgical trainees/early-stage residents). Results Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytic themes. First, the complexity of the surgical training system and wider healthcare education context, and how this influenced the development of BC. Second, participants’ views of BC as a vehicle not just for learning skills but for gaining “insider information” on how best to progress in surgical training. Finally, the explicit aim of Faculty to use Scottish Surgical Bootcamp (SSBC) to welcome trainees/residents into the world of surgery, and how this occurred.Discussion To the best of our knowledge, this is the first empirical study of a surgical BC which takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that BC is as much about social and cultural processes as it is individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research.

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