Using Self-Determination Theory to Ease the Transition into Residency: A Program Evaluation

Purpose: Literature demonstrates that graduating medical students are not sufficiently prepared to perform daily tasks as an intern such as manage postoperative emergencies and giving verbal handovers. Some residencies offer “boot camp” courses. However, these boot camp courses are often time-limited in implementation, competing with other orientation events. The purpose of this study was to address the continued need for better preparation of incoming surgical residents, implementing a new curriculum grounded on the psychological principles of Self-Determination Theory (SDT). Methods: We developed a targeted curriculum, mailing incoming interns curricular materials. In creation of the content, we utilized local experts within their respective fields to create short video tutorials: internal medicine on perioperative glycemic and antihypertensive management, pain management on perioperative opioid and multimodal analgesia concepts, and pediatrics on pediatric patient management. The in-person curriculum consisted of hands-on mentored practice and assessments of skills. The program was evaluated with a pre and post-survey on self-perceived preparedness. A delayed assessment (four months into the academic year) of surgical skills was also conducted. We framed our analysis based on the three core principles within SDT: Competence, Autonomy, and Relatedness. Results: 34 residents participated in the program. When evaluating for Competence, pre-and post-survey responses on self-perceived preparedness showed a significant increase in “Medical Knowledge” and “Patient Care” competencies. When evaluating for Autonomy, there was a significant increase with suturing (p = 0.03) and knot-tying (p = 0.02) and a decrease in mistakes with atraumatic tying (p = 0.02). In the post-survey, learners overwhelmingly preferred the hybrid remote/in-person format and their open-ended prompt responses highlighted the aspects of Relatedness in the curriculum. Conclusions: We used SDT to motivate incoming residents to asynchronously direct their own learning first through a formalized curriculum and then maintained during the academic year. We were able to offload the time- and content-limited format of traditional “boot camps,” while helping residents maintain this momentum through the year.