Table 2 Scottish Surgical Boot Camp

In designing the Scottish Surgical Boot Camp (SSBC), the surgical training faculty in Inverness, Scotland, set out to define and include skills, attitudes, and even values that seemed essential for a safe and “flying” start to surgical training. The content was derived from their observations as trainers of where surgeons (especially trainees) tend to struggle and of which skills had previously been learned “the long way” by apprenticeship or prolonged clinical exposure, or sometimes never learned at all, and which now could be taught early on using a new paradigm of training. Hence, alongside technical skills such as bowel anastomosis and laparoscopic instrument handling, the programme includes sessions devoted to non-technical skills in complex real-life settings, e.g. the leading of a simulated ward round in the face of distractions and the handling of difficult written or spoken communication scenarios. Also included are anecdotal lessons in resilience.

First piloted in 2011, the SSBC was adopted in 2014 by the two Core Surgical Training programmes in Scotland as their introductory course for new start trainees, endorsed by two surgical Royal Colleges (Edinburgh and Glasgow) and fees are subsidised by the NHS Education for Scotland, the body which oversees training for all doctors and healthcare professionals.

The current iteration of the programme is shown in Fig. 2. Most sessions include SBE, and it is not difficult to see from the programme how as a whole it mimics the structure of a “surgical day” and “surgical week”. Also built in is an adherence to Issenberg’s highly evidence-based 10 conditions for effective simulation-based learning [70]. For example, skills are practised in a variety of clinical settings, in valid and controlled simulations, with immediate and individualised feedback.

The technical tasks taught and practised using pig tissue in the “wet labs” are limited to two defined, useful tasks not easily accessible to the new start trainee in real clinical practice, which require discipline and repetition and in which the learner rapidly feels the benefit of repetition. These are small bowel anastomosis, skin flaps, and/or tendon repair. The non-technical skills are taught using the well-established taxonomy “Non-Technical Skills for Surgeons” [71] (NOTSS) and using varying simulated phone call scenarios and a simulated ward round with detailed individual feedback on the core NOTSS behavioural constructs (situation awareness, decision-making, communication and teamwork, and leadership).

Educational theory has been used to understand the complex processes of the Boot Camp by way of a qualitative study [72].