# Design and evaluation of a surgical boot camp: a step-by-step guide to curriculum development and impact assessment

Géraud Galvaing, Alexandre Lautrette, Thomas Godet, Clémentine Millet, Guillaume Daniel, Yann Barthelemy, Lionel Camilleri, Charline Helyette Pujos, Nicolas D'ostrevy

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Géraud Galvaing, Alexandre Lautrette, Thomas Godet, Clémentine Millet, Guillaume Daniel, et al. Design and evaluation of a surgical boot camp: a step-by-step guide to curriculum development and impact assessment. BMC Medical Education, 2025, 25, pp.874. 10.1186/s12909-025-07545-5. hal-05458293

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# Design and evaluation of a surgical boot camp: a step-by-step guide to curriculum development and impact assessment

Géraud Galvaing¹, Alexandre Lautrette², Thomas Godet³, Clémentine Millet<fnref n="4" />, Guillaume Daniel⁵, Yann Barthelemy⁶, Lionel Camilleri⁶,⁷, Charline Helyette Pujos⁶ and Nicolas D'Ostrevy⁶,⁷,⁸*

**Abstract**

**Background** The transition from medical school to surgical residency often leaves students underprepared for essential technical procedures, impacting their confidence and patient safety. Surgical boot camps can help address this skill gap, but few articles have described exactly how to organize a boot camp. We aimed to precisely describe the simulation stations and evaluate the effectiveness of the boot camp.

**Methods** We conducted a prospective, monocentric, observational study at the University Hospital of Clermont-Ferrand (France) over a 3-year period, assessing technical skills and cognitive workload before and after boot camp using a validated questionnaire. We included sixty-five medical students (34 female, 31 male) who had been accepted into a general surgery residency program were included. We described precisely the 9 simulation stations.

**Results** After the boot camp, participants reported increased confidence in basic surgical skills, with significant improvements in technical performance. Satisfaction scores were high, averaging 8.8 out of 10 for women and 9.0 for men. Segmenting the boot camp into multiple workshops made it easy to organize.

**Conclusion** This surgical boot camp significantly reduced the perceived cognitive workload and improved the confidence of incoming residents, addressing key challenges in pre-residency preparation. By providing a detailed description of our simulation workshops, we aim to facilitate the implementation of similar programs in other institutions.

**Keywords** Medical education, Simulation training, Internship and residency, Surgical equipment

<footnote>*Correspondence:
Nicolas D'Ostrevy
ndostrevy@chu-clermontferrand.fr

¹Thoracic Surgery Department, Centre Jean Perrin, Clermont-Ferrand, France

²Intensive Care Unit, Centre Jean Perrin, Clermont-Ferrand, France

³Department of Perioperative medicine, University Hospital, Clermont-Ferrand, France</footnote>

<footnote n="4">⁴Urology Department, University Hospital, Clermont-Ferrand, France

⁵Vascular Surgery Department, Medipôle, Lyon, France

⁶Cardiac Surgery Department, University Hospital, Clermont-Ferrand, France

⁷TGI ISIT, Institut Pascal, Clermont-Ferrand, France

⁸Service de chirurgie cardiaque, CHU de Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand 63000, France</footnote>
## Background

In France, following three years of theoretical course-work, medical students enter a clinical training program (externship/pre-residency) during which they participate in hospital activities across various departments. At the end of the sixth year, students are ranked nationally based on a competitive examination and select their residency position—including university center and specialty—from a ministerial list [1].

Although the process differs slightly from the U.S. system, it similarly results in a “matching day,” where students trained at one university may complete their residency at another institution. This process does not distinguish between medical and surgical tracks. As a result, surgical exposure prior to residency is highly variable, depending on the medical school of origin.

In addition, a regulatory option known in France as the “droit au remord” allows residents to request a change of specialty within their first year of training. In surgical fields, this rate can reach up to 22%, suggesting that a substantial proportion of new residents may feel misaligned with their chosen specialty—possibly due to insufficient exposure or inadequate preparation during earlier stages of training. This phenomenon further highlights the need for structured, early interventions to support career decision-making and ensure readiness for surgical practice. The internship (residency) itself is a full-time, hospital-based program, complemented by one day per week of university instruction, during which residents actively participate in patient care, particularly in surgical disciplines.

The transition of medical students from their pre-residency curriculum to their surgical residency is a significant challenge. Students often find themselves inadequately prepared to perform the technical procedures required in surgery. Indeed, basic hands-on skills are frequently overlooked in pre-residency training, resulting in stress, increased anxiety, and lack of confidence in new residents. Parent et al. highlighted that this gap in the training of new residents on the eve of their responsibilities could have serious implications for the quality of care provided, as residents may feel incompetent to perform certain essential technical procedures [2]. This issue is exacerbated by the increase in the number of medical students, the reduction in available clinical placements in surgical specialties, and legal restrictions on working hours, particularly the European Working Time Directive [3]. This regulation limits the work week to 48 h, which significantly reduces the amount of time residents can spend on hands-on clinical activities, including surgical exposure in the operating room. In addition, the “never first time on the patient” principle further reduces clinical exposure in favor of prior training through simulation or on models [4]. In France, the

principle of “never the first time on the patient” is widely accepted as a pedagogical and ethical standard. However, there is currently no official regulation mandating that all procedures must be practiced in simulation before being performed on real patients by residents. As a result, this principle remains an aspirational goal rather than an enforceable requirement. While surgical societies across various specialties increasingly recognize the legal and moral imperative of simulation-based training, the transition toward systematic, standardized, and assessed simulation for all surgical residents is still ongoing. Implementation levels vary considerably between specialties, and simulation remains inconsistently integrated into residency curricula. To address these challenges, surgical boot camps have emerged as a promising solution. A growing number of such programs have been developed internationally to ease the transition into surgical residency. As summarized in a recent systematic review by Young et al. [5], successful boot camps are typically offered at key transitional periods and share five core components: delivery at the start of training, a level-appropriate syllabus, use of multimodal simulation (technical and non-technical skills), deliberate practice with formative feedback, and, where feasible, a 1:1:1 trainee-instructor-task ratio. These features have been shown to reduce cognitive overload, improve confidence, accelerate skill acquisition, and enhance patient safety at the start of residency. These intensive training programs are designed to allow future residents to quickly acquire essential technical and non-technical skills before beginning their residency. They are typically short, focused, and intensive, ranging from 1 day to 3 months, and are often scheduled around the time residents begin their surgical residency or during key transitional periods in their training [5].

The primary goal of surgical boot camps is to ease the transition into residency by improving patient safety and reducing the well-documented “July phenomenon” (also referred to as the “August effect” in the UK), which describes a temporary decline in the quality of care and an increase in medical errors associated with the arrival of new, inexperienced residents at the start of the academic year [6]. Although less extensively studied, a similar situation is observed in France on November 2nd, when new residents begin their hospital duties, potentially leading to comparable risks in clinical performance and patient safety.

Surgical boot camps have consistently been shown to improve residents' confidence and technical skills [7, 8]; however, few studies provide detailed descriptions of their content, materials, objectives, or evaluation methods. Nevertheless implementing such programs also faces financial and logistical challenges—especially in
publicly funded systems like France, where universities operate with limited autonomy and constrained budgets.

This challenge is exacerbated by a sharp increase in the number of medical students in recent years, without a proportional expansion of surgical training opportunities or infrastructure. For instance, the number of students admitted annually to the second year of medical school in France rose from 3,850 in 2000 to 9,361 in 2020, as determined each year by ministerial decree. Despite this increase, the number of available surgical procedures and training positions has remained relatively stable. This growing demand, coupled with static resources, restricts students' hands-on surgical experience and complicates the implementation of resource-intensive educational interventions such as boot camps. Similarly, access to qualified instructors, simulation equipment, and institutional funding has not kept pace with the increasing number of trainees. In response to these challenges, the following project was developed to enhance residents' preparedness before beginning their surgical training in Clermont-Ferrand.

## Project description

The teaching of basic surgical techniques cannot be separated from theoretical instruction, particularly the minimum knowledge required to understand the relevance of these techniques.

Over the past six years, we have developed and implemented a training program designed for all future surgical residents at our university hospital. This three-day educational program alternates between lectures and practical workshops using low-fidelity simulation, as we believe that the high cost of high-fidelity mannequins or animal models is not justified for students at the end of their pre-residency curriculum. Therefore, we chose to deliver this training each year during the month of October, ensuring that it does not impact hospital operations. Moreover, we aimed to conduct this program before the residents' official start date to ease their transition into clinical practice. The Faculty of Medicine of Clermont-Ferrand fully funds and organizes all aspects of this program, including logistical and human resources.

## Methods

### Preliminary organization

Between 2020 and 2022, all medical students newly assigned to a surgical residency at our university hospital (n=65) were invited to participate in the boot camp. Inclusion criteria consisted of being admitted into a surgical residency program at our institution. No exclusion criteria were applied. Participation was voluntary, and all eligible residents accepted and completed the training, resulting in a participation rate of 100%.

Therefore, the organization of the boot camp begins as soon as we are informed of the residents assigned to our university, through a questionnaire that allows us to assess each resident's previous surgical exposure and to identify any global or individual gaps in their knowledge, in order to tailor the teaching provided. The pre-boot camp questionnaire was developed by the faculty team based on curricular objectives and reviewed by three senior surgical educators for face validity. It was not formally piloted or psychometrically validated, which we acknowledge as a limitation of the study. Herein, we present the results of the last three years.

To better understand the variability in prior surgical exposure, our questionnaire collected data across five distinct levels: (1) number of surgical rotations, (2) number of days present in the OR, (3) number of days scrubbed in, (4) number of procedures performed as first assistant, and (5) number of procedures performed as scrub nurse.

This approach was necessary due to the considerable variability observed across French medical schools, where pre-residency surgical rotations may last from six weeks (full-time) to three months (part-time), and where operating room access is not guaranteed. Moreover, presence in the OR does not systematically imply participation in the procedure, nor sterile involvement. Roles may range from simple observation to active assistance.

The teaching sessions are structured so that lectures take place at the beginning of the day according to a schedule that allows for corresponding hands-on activities to follow immediately. We have designed a flexible schedule to ensure that the lectures are kept to a minimum, thereby maximizing the time devoted to hands-on activities.

## Lectures

The sequence of lectures has been planned to prioritize those topics that require the most hands-on time. Over the course of three days, the following topics are covered:

### Day 1

* Suture materials and needles.

* Surgical suturing technique.

* Postoperative drainage.

### Day 2

* Skin preparation for surgery.

* Hand washing, dressing, gloving, and sterile draping.

* Surgical instrumentation.

* Principles of surgical equipment sterilization.
## Day 3

* Operating room architecture and standards.

* Operating room lighting technologies.

* Operating table technologies, supports, and surgical setup.

* Electrosurgery, energy devices, and stapling.

## Hands-On training

As previously explained, the hands-on training sessions are aligned with the corresponding theoretical lectures. The hands-on exercises are conducted using low-fidelity workshops, including a low-fidelity simulator of our own design. The workshops are described in detail in Appendix 1 to eAppendix 9 in Supplement 1.

Workshops 1 to 3 focus on the hand movements required to perform surgical knots manually. These workshops provide a detailed explanation of various surgical knots, using different sutures of varying diameters. A technical drawing of the knot training board is provided in Fig. 1. The Fig. 2 shows a photograph of the tubular insert simulating a deep suture. (Figures 1 and 2 in supplementary files)

Workshops 4 and 5 address the use of needle drivers and dissecting forceps, with special emphasis on working with the non-dominant hand (Supplementary files, Fig. 3). These workshops are conducted in a group setting to reinforce teamwork. We are also preparing additional workshops that focus on teamwork in the operating room, but these workshops do not take place during the boot camp and are therefore not described here.

Workshops 6 and 7 focus on the performance of surgical sutures. Students learn to perform simple stitches, interrupted sutures, corner stitches, as well as deep, superficial, and intradermal sutures. We also teach them how to secure a surgical drain, and for residents specializing in microsurgery, we introduce basic microsurgical concepts and suturing under a surgical loupe.

Workshops 8 and 9 cover hand washing, dressing, gloving, draping, and positioning on the operating table. For added realism, these workshops are conducted either in the anatomy lab operating room or in a section of our hospital's operating room during off-hours.

All workshops end with a debriefing session. While this marks the end of a low-fidelity simulation session, it is an integral part of the process, just as it would be in a high-fidelity simulation session [9, 10]. Its importance is well documented and provides an opportunity to discuss problematic aspects of the technique practiced, as well as exercises that can be performed independently after the training session [11].

Residents' cognitive workload was evaluated using the NASA Raw Task Load Index (NASA-TLX), a validated psychometric instrument designed to quantify perceived

mental effort in surgical tasks. Participants rated workload dimensions such as mental demand, effort, and performance. Impostor phenomenon was assessed using the Clance Impostor Phenomenon Scale (CIPS), a validated 20-item questionnaire designed to measure feelings of self-doubt and perceived fraudulence. Each item is rated on a 5-point Likert scale, ranging from 1 ("not at all true") to 5 ("very true"), with total scores ranging from 20 to 100—higher scores indicating more intense impostor feelings. This scale has been validated in medical education settings [12, 13]. At the end of the boot camp, students' satisfaction with the content and organization of the training was evaluated using a Likert scale.

## Statistical analysis

Data analysis was performed with R version 4.4.0. A two-sided type I error rate of 5% was used for all analyses. Categorical variables were described using frequencies and percentages, whereas quantitative variables were presented as mean ± standard deviation. Nominal and numeric outcomes were compared using chi-squared test and Student's t-test. The statistical approach was primarily descriptive, in line with the exploratory and observational nature of the study. Given the small cohort size and the focus on implementation outcomes, descriptive statistics and basic comparisons were deemed most appropriate for addressing the study objectives.

## Results

Over the past 3 years, 34 women and 31 men have benefited from the training provided by our surgical education program, with approximately one-third having completed their pre-residency curriculum at our university center. While most were right-handed, their lateralization differed slightly from that of the general population, with fewer left-handed males (6%) and a higher percentage of left-handed females (23%) compared to the global population. Although the benefit of video gaming in surgical learning has been demonstrated in robotic [14] and laparoscopic surgery [15], our population did not report sufficient video game use to allow for meaningful comparison. Detailed participant characteristics, prior surgical experience, and exposure are summarized in Table 1, while self-reported confidence levels, cognitive workload scores, and satisfaction ratings are presented in Table 2.

However, there was a notable male predominance among the most dedicated gamers, with 19% of the male population compared to 11% of the female population.

Prior to residency, surgical exposure among participants was substantial but highly variable. On average, residents had completed between 4.1 and 4.65 surgical rotations, with considerable standard deviations in both male and female groups. Approximately one-third of residents had spent fewer than 40 days in the operating
<table><caption>**Table 1** Participant characteristics and surgical experience</caption><thead><tr><th>Parameter/question</th><th>Possible answers</th><th>Female (N=34)</th><th>Male (N=31)</th><th>P-value</th></tr></thead><tbody><tr><td>Pre-residency and residency in the same university</td><td></td><td>10 (29%)</td><td>11 (35%)</td><td>NS</td></tr><tr><td>Right-handed</td><td></td><td>26 (76%)</td><td>29 (94%)</td><td>NS</td></tr><tr><td>Left-handed</td><td></td><td>8 (24%)</td><td>2 (6%)</td><td></td></tr><tr><td>Ambidextrous</td><td></td><td>0 (0%)</td><td>0 (0%)</td><td></td></tr><tr><td>Play videogames</td><td>Never</td><td>22 (65%)</td><td>15 (48%)</td><td>NS</td></tr><tr><td></td><td>&lt;7 h/week</td><td>8 (24%)</td><td>10 (32%)</td><td></td></tr><tr><td></td><td>7–14 h/week</td><td>4 (12%)</td><td>6 (19%)</td><td></td></tr><tr><td>Play music</td><td>Never</td><td>25 (74%)</td><td>21 (68%)</td><td>NS</td></tr><tr><td></td><td>&lt;7 h/week</td><td>6 (18%)</td><td>8 (26%)</td><td></td></tr><tr><td>Hands-on hobbies</td><td>Never</td><td>13 (38%)</td><td>11 (35%)</td><td>NS</td></tr><tr><td></td><td>&lt;7 h/week</td><td>21 (62%)</td><td>20 (65%)</td><td></td></tr><tr><td>Number of surgical rotations (6-week to 3-month periods) during the pre-residency phase (Mean +/- SD)</td><td></td><td>4.1 (+/- 1.9)</td><td>4.65 (+/-1.9)</td><td>NS</td></tr><tr><td>Number of days present in the operating room</td><td>&lt;40</td><td>10 (29%)</td><td>9 (29%)</td><td>NS</td></tr><tr><td></td><td>&gt;40</td><td>24 (71%)</td><td>22 (71%)</td><td></td></tr><tr><td>Number of days scrubbed</td><td>&lt;40</td><td>21 (62%)</td><td>13 (42%)</td><td>NS</td></tr><tr><td></td><td>&gt;40</td><td>13 (38%)</td><td>18 (58%)</td><td></td></tr><tr><td>Number of procedures performed as first assistant</td><td>&lt;30</td><td>30 (88%)</td><td>21 (68%)</td><td>p=0.04</td></tr><tr><td></td><td>&gt;30</td><td>4 (12%)</td><td>10 (32%)</td><td></td></tr><tr><td>Number of procedures performed as scrub nurse</td><td>&lt;30</td><td>26 (76%)</td><td>25 (81%)</td><td>NS</td></tr><tr><td></td><td>&gt;30</td><td>8 (24%)</td><td>6 (19%)</td><td></td></tr><tr><td>Have you ever performed the following?</td><td>Simple skin suture</td><td>33 (97%)</td><td>31 (100%)</td><td>NS</td></tr><tr><td></td><td>Intradermal running suture</td><td>22 (65%)</td><td>19 (61%)</td><td>NS</td></tr><tr><td></td><td>Deep running suture</td><td>7 (21%)</td><td>8 (26%)</td><td>NS</td></tr><tr><td></td><td>Hemostatic stitch</td><td>4 (12%)</td><td>11 (35%)</td><td>NS</td></tr><tr><td></td><td>Drain fixing</td><td>13 (38%)</td><td>16 (52%)</td><td>NS</td></tr><tr><td></td><td>Sterile field draping</td><td>22 (65%)</td><td>15 (48%)</td><td>NS</td></tr><tr><td></td><td>Urinary tract catheterization</td><td>25 (74%)</td><td>19 (61%)</td><td>NS</td></tr><tr><td></td><td>Suprapubic catheterization</td><td>0 (0%)</td><td>1 (3%)</td><td>NS</td></tr><tr><td></td><td>Chest tube placement</td><td>6 (18%)</td><td>3 (10%)</td><td>NS</td></tr><tr><td></td><td>Put on sterile gloves</td><td>34 (100%)</td><td>31 (100%)</td><td>NS</td></tr><tr><td></td><td>Put on a sterile gown</td><td>34 (100%)</td><td>31 (100%)</td><td>NS</td></tr><tr><td></td><td>Tying a knot with a needle driver</td><td>31 (91%)</td><td>28 (90%)</td><td>NS</td></tr><tr><td></td><td>Tying a knot manually</td><td>19 (56%)</td><td>13 (42%)</td><td>NS</td></tr></tbody></table>

room. Among these days, only a subset involved being scrubbed. Importantly, being scrubbed did not always imply active participation in the procedure—some residents remained passive, while others assisted actively, either as first assistant or as scrub nurse. This stratification allowed us to more accurately characterize the heterogeneity in pre-residency operative experience. Lastly, the performance of hands-on procedures was rare, except for simple sutures and intradermal sutures. Nonetheless, this limited exposure did not translate into a lack of confidence among those who had already performed the procedure prior to the boot camp. “Among the various procedures assessed, deep suturing and sterile draping were perceived as the least mastered skills by students prior to the boot camp training.” Impostor

phenomenon was assessed using the Clance Impostor Phenomenon Scale (CIPS) [13], which ranges from 20 to 100, with higher scores indicating more intense impostor feelings. Scores between 41 and 60 reflect moderate impostor phenomenon, and scores between 61 and 80 indicate frequent impostor feelings. In our cohort, male residents had a mean score of 56.2 ± 9.7, and female residents 56.4 ± 13.3. This difference was not statistically significant (p = NS), indicating strong confidence for the majority of future residents.

Before the training, the mean mental workload score was 41.7 ± 8 for male residents and 44.7 ± 7 for female residents, with a statistically significant difference (p < 0.01). After the boot camp, scores decreased in both groups—36.6 ± 7 for males and 39.0 ± 7 for
<table><caption>**Table 2** Self-Confidence, cognitive workload, and satisfaction</caption><thead><tr><th>Parameter/question</th><th>Possible answers</th><th>Female (N=34)</th><th>Male (N=31)</th><th>P-value</th></tr></thead><tbody><tr><td>I think I know how to do it well (/10);<br/>1: I believe I have absolutely no ability to perform this correctly.</td><td>I think I know how to tie a knot with a needle driver</td><td>6.2 (+/-2.4)</td><td>5.1 (+/-3.2)</td><td>NS</td></tr><tr><td rowspan="3">10: I believe I can perform this correctly and without error,</td><td>I think I know how to tie a surgical knot manually</td><td>8 (+/-1.7)</td><td>8.3 (+/-1.5)</td><td>NS</td></tr><tr><td>I think I know how to do a deep running suture</td><td>3.6 (+/-2.8)</td><td>3.1 (+/-2.7)</td><td>NS</td></tr><tr><td>I think I know how to do an intradermal running suture</td><td>5.1 (+/-2.5)</td><td>4.7 (+/-2.3)</td><td>NS</td></tr><tr><td>I think I know how to put the sterile draping</td><td>4.4 (+/-2.5)</td><td>4.1 (+/-2.3)</td><td>NS</td></tr><tr><td>Clance Impostor Phenomenon Scale (/100)</td><td></td><td>56.2+/- 9.7</td><td>56.4 +/- 13.3</td><td>NS</td></tr><tr><td>Few impostor characteristics</td><td>≤40</td><td>4 (12%)</td><td>1 (3%)</td><td>NS</td></tr><tr><td>Moderate impostor phenomenon</td><td>41-60</td><td>13 (38%)</td><td>18 (58%)</td><td></td></tr><tr><td>Frequent impostor feelings</td><td>61-80</td><td>16 (47%)</td><td>10 (32%)</td><td></td></tr><tr><td>Intense impostor experiences</td><td>≥81</td><td>1 (3%)</td><td>2 (6%)</td><td></td></tr><tr><td>NASA Raw TLX mental workload</td><td></td><td>41.7 (+/-8)</td><td>44.7 (+/-7)</td><td>&lt; 0.01</td></tr><tr><td>Simple suture pre-boot camp</td><td></td><td></td><td></td><td></td></tr><tr><td>NASA Raw TLX mental workload</td><td></td><td>36.6 (+/-7)</td><td>39 (+/-7)</td><td>NS</td></tr><tr><td>Simple suture post-boot camp</td><td></td><td></td><td></td><td></td></tr><tr><td>Satisfaction with the boot camp (/10)</td><td></td><td>8.8 (+/-0.8)</td><td>9 (+/- 0.9)</td><td>NS</td></tr></tbody></table>

females—though this difference was no longer statistically significant (p = NS). Finally, residents' satisfaction after the boot camp was very high, with a mean score of 8.8 ± 0.8 for female participants and 9.0 ± 0.9 for male participants (p = NS), supporting the continuation of this type of training.

# Discussion

## Summary of findings

Our study highlights considerable variability in surgical exposure among incoming surgical residents, reflecting substantial differences in practical training across medical institutions. Despite these variations, residents generally reported high confidence in their surgical skills at the start of their residency. Participation in our structured three-day surgical boot camp significantly reduced residents' perceived cognitive workload when performing basic surgical tasks and led to high satisfaction scores. These outcomes emphasize the value of concise, targeted simulation programs to address skill deficiencies during the critical transition period into surgical residency.

## Comparison with existing literature

Previous literature, largely based in the United States, has consistently demonstrated the effectiveness of surgical boot camps in enhancing trainee confidence and preparedness for clinical practice [16, 17]. For instance, Choron et al. [18] showed that a two-week surgical boot camp significantly improved medical students' confidence across various technical skills and knowledge areas, although it did not affect levels of impostor phenomenon. Similarly, Desir et al. [19] and Acosta et al. [20] reported substantial gains in intern confidence and perceived technical competence following structured

preparatory programs. However, these programs were developed within the US medical education framework, which differs markedly from the French context in terms of curriculum structure, clinical exposure, and institutional resources. In contrast, our study presents a reproducible and cost-effective boot camp model tailored to the realities of public medical education in France.

However, existing publications generally lack detailed descriptions of the individual workshops that constitute these boot camps, typically providing only general outlines of topics such as suturing, laparoscopy, or non-technical skills. This absence of specific details significantly hampers reproducibility and broader implementation of effective boot camps. Our study addresses this critical gap by providing comprehensive descriptions of each workshop, including learning objectives, skillsets taught, and the materials required.

The low-fidelity nature and simplicity of the materials used in our workshops further enhance their accessibility and adaptability, aligning with findings [21] who highlighted the efficacy of low-cost, reproducible simulation models in surgical training, especially in resource-limited environments. Moreover, a systematic review in 2020 [22] reinforced the effectiveness of low-fidelity simulations when combined with structured training and appropriate feedback mechanisms, supporting the educational validity of our approach.

## Strengths and limitations

A primary strength of our boot camp is its reproducibility, facilitated by the use of low-cost and readily accessible materials. Our prospectively collected data over three consecutive years from a complete cohort of incoming surgical residents adds robustness and reliability to our
findings. Nevertheless, several limitations warrant critical consideration. The reliance on self-assessment tools, such as NASA-TLX and the Clance Impostor Phenomenon Scale, to measure cognitive workload and confidence levels presents inherent subjectivity and limits the ability to objectively confirm actual skill improvements. Studies by Bevilacqua et al. [23] and Wang et al. [24] highlight the importance of integrating objective performance measures, including expert-based assessments, which we did not include. Additionally, the lack of a control group restricts our capacity to directly attribute observed benefits solely to the boot camp intervention. The absence of long-term follow-up further limits our understanding of the persistence of these initial benefits into clinical practice. Lastly, logistical constraints meant we were unable to incorporate training on minimally invasive or robotic techniques, which represent significant areas of contemporary surgical practice. Future studies should prioritize the integration of objective performance evaluations, controlled comparative designs, and longitudinal assessments to better capture the lasting impact and overall effectiveness of boot camps. In line with this, a recent study by Sharon [25] analyzed long-term skill acquisition in robot-assisted minimally invasive surgery, highlighting the importance of training intervals and the effects of fatigue on performance, thereby underscoring the need for longitudinal assessments in surgical training programs.

## Implications and future directions

In contrast to countries such as the United States, Canada, or the United Kingdom—where national surgical boards define structured prerequisites for boot camp training [26, 27]—France currently lacks such standardized national guidelines. This regulatory gap contributes to significant variability in surgical exposure among residents and may partly explain the high rate of specialty changes during the early years of residency.

Our findings highlight the importance of accessible, low-cost preparatory training such as surgical boot camps to support residents during this transitional phase. At our institution, the initial boot camp is integrated into a broader educational framework, including additional targeted sessions throughout the academic year. These follow-up sessions cover advanced skills in minimally invasive, robotic, and emergency surgery.

Future research should explore the long-term effects of such structured training, including knowledge retention, sustained skill development, and the added value of repeated practice. Objective assessment tools—such as direct observation and performance-based evaluations—should be incorporated to complement subjective self-assessments and provide more robust evidence of training efficacy.

## Conclusion

In conclusion, this study underscores significant variability in surgical exposure among incoming surgical residents in France. It demonstrates that a structured, low-fidelity surgical boot camp can effectively improve residents' self-perceived cognitive workload and confidence at the onset of their residency. Our detailed descriptions of workshops address a critical gap in the existing literature, facilitating broader replication of such training programs. Despite limitations related to self-assessment and absence of objective performance measures, our findings support the wider adoption of accessible, low-cost boot camps as essential preparatory components in surgical education. Future studies should incorporate objective assessments, controlled comparative designs, and longitudinal follow-up to further validate and refine these training programs.

## Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12909-025-07545-5.

Supplementary Material 1: Technical Drawing of the Knot Training Board

Supplementary Material 2: Photograph of the Tubular Insert Simulating a Deep Suture

Supplementary Material 3: Non-Dominant Hand Exercise Station

Supplementary Material 4

## Acknowledgements

Not applicable.

## Author contributions

GG: conception, design, draft AL: conception, data curation, review TG: conception, data curation, review CM: data acquisition, data analysis GD: data acquisition, data analysis YB: data acquisition, data analysis LC: data acquisition, data analysis CHP: data acquisition, data analysis NDO: conception, design, data acquisition, data analysis, draft.

## Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

## Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to nominative information, but an anonymized version is available from the corresponding author upon reasonable request.

## Declarations

### Ethics approval and consent to participate

The ethics committee that waived the requirement for informed consent is the Jean Perrin Cancer Institute Ethics Committee, located in Clermont-Ferrand (France). Approval was granted under reference number CJP-2025-01. The Institutional Review Board (IRB) of the Jean Perrin Center granted a waiver of informed consent for this study, due to the nature of the study protocol and its specific characteristics. All of our research was conducted in compliance with the Declaration of Helsinki.

### Consent for publication

Non Applicable.
**Competing interests**

The authors declare no competing interests.

**Clinical trial Number**

Not applicable.

Received: 7 February 2025 / Accepted: 13 June 2025

Published online: 01 July 2025

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