1
|
Anetzberger H, Kugler A, John D, Kopf S, Becker R, Reppenhagen S. The number of arthroscopies performed by trainees does not deduce the level of their arthroscopic proficiency. Knee Surg Sports Traumatol Arthrosc 2023; 31:4231-4238. [PMID: 37296326 DOI: 10.1007/s00167-023-07471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE It is reasonable to question whether the case volume is a suitable proxy for the manual competence of an arthroscopic surgeon. The aim of this study was to evaluate the correlation between the number of arthroscopies previously performed and the arthroscopic skills acquired using a standardized simulator test. METHODS A total of 97 resident and early orthopaedic surgeons who participated in arthroscopic simulator training courses were divided into five groups based on their self-reported number of arthroscopic surgeries: (1) none, (2) < 10, (3) 10 to 19, (4) 20 to 39 and (5) 40 to 100. Arthroscopic manual skills were evaluated with a simulator by means of the diagnostic arthroscopy skill score (DASS) before and after training. Seventy-five points out of 100 must be achieved to pass the test. RESULTS In the pretest, only three trainees in group 5 passed the arthroscopic skill test, and all other participants failed. Group 5 (57 ± 17 points; n = 17) scored significantly higher than the other groups (group 1: 30 ± 14, n = 20; group 2: 35 ± 14, n = 24; group 3: 35 ± 18, n = 23; and group 4: 33 ± 17, n = 13). After a two-day simulator training, trainees showed a significant increase in performance. In group 5, participants scored 81 ± 17 points, which was significantly higher than the other groups (group 1: 75 ± 16; group 2: 75 ± 14; group 3: 69 ± 15; and group 4: 73 ± 13). While self-reported arthroscopic procedures were n.s. associated with higher log odds of passing the test (p = 0.423), the points scored in the pretest were found to be a good predictor of whether a trainee would pass the test (p < 0.05). A positive correlation was observed between the points scored in the pretest and the posttest (p < 0.05, r = 0.59, r2 = 0.34). CONCLUSIONS The number of previously performed arthroscopies is not a reliable indicator of the skills level of orthopaedic residents. A reasonable alternative in the future would be to verify arthroscopic proficiency on the simulator by means of a score as a pass-fail examination. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Hermann Anetzberger
- Orthopädische Gemeinschaftspraxis am OEZ, Hanauer Str. 65, 80993, Munich, Germany.
| | - Andreas Kugler
- Zentrum für Gelenkchirurgie im MVZ am Nordbad, Schleißheimer Straße 130, 80797, Munich, Germany
| | - Dominik John
- Gelenk.Bonn, Bonner Talweg 61, 53113, Bonn, Germany
| | - Sebastian Kopf
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Brandenburg der Medizinischen Hochschule Brandenburg Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Roland Becker
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Brandenburg der Medizinischen Hochschule Brandenburg Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Stephan Reppenhagen
- Orthopädische Klinik König-Ludwig-Haus, Brettreichstraße 11, 97074, Würzburg, Germany
| |
Collapse
|
2
|
Fischer J, Barbois S, Quesada JL, Boddaert G, Haen P, Bertani A, Duhamel P, Delmas JM, Lechevallier E, Piolat C, Rongieras F, Tresallet C, Balandraud P, Arvieux C. Early Evaluation of a New French Surgery Course in the Best Practice of Dealing With Major Incidents and Mass Casualty Events. JOURNAL OF SURGICAL EDUCATION 2023; 80:1253-1267. [PMID: 37429782 DOI: 10.1016/j.jsurg.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The main objective of this study is to evaluate the impact of a nationwide 5-month course aimed to prepare surgeons for Major Incidents through the acquisition of key knowledge and competencies. Learners' satisfaction was also measured as a secondary objective. DESIGN This course was evaluated thanks to various teaching efficacy metrics, mainly based on Kirkpatrick's hierarchy in medical education. Gain in knowledge of participants was evaluated by multiple-choice tests. Self-reported confidence was measured with 2 detailed pre and post training questionnaires. SETTING Creation in 2020 of a nationwide, optional and comprehensive Surgical Training in War and Disaster Situation as part of the French surgery residency program. In 2021, data was gathered regarding the impact of the course on participants' knowledge and competencies. PARTICIPANTS The study included 26 students in the 2021 cohort (13 residents and 13 practitioners). RESULTS Mean scores were significantly higher in the post-test compared to the pre-test, showing significant increase in participants' knowledge during the course: 73,3% vs. 47,3% respectively (p ≤ 0.001). Average learners' confidence scores to perform technical procedures showed at least a +1-point increase on the Likert scale for 65% of items tested (p ≤ 0.001). 89% of items showed at least a +1-point increase on the Likert scale when it came to average learners' confidence score on dealing with complicated situations (p ≤ 0.001). Our post-training satisfaction survey showed that 92% of all participants have noticed the impact of the course on their daily practice. CONCLUSION Our study shows that the third level of Kirkpatrick's hierarchy in medical education was reached. This course therefore appears to be meeting the objectives set by the Ministry of Health. Being only 2 years old, it is on the road to gathering momentum and further development.
Collapse
Affiliation(s)
- Juliette Fischer
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.
| | - Sandrine Barbois
- Inria, CNRS, Grenoble INP, LJK, University Grenoble Alpes, Grenoble, France; Department Of Digestive and Acute Care Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 university, Lyon, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Guillaume Boddaert
- Department of Thoracic and Vascular Surgery, Percy Military Academic Hospital, Clamart Cedex, France
| | - Pierre Haen
- Department of Maxillofacial Surgery, Laveran Military and Academic Hospital, Marseille, France
| | - Antoine Bertani
- Department of Orthopaedics and Trauma, Edouard Herriot Hospital, Lyon, France
| | - Patrick Duhamel
- Department of Plastic surgery, Percy Military Academic Hospital, Clamart, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Academic Hospital, Clamart, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, AP-HM, Conception Academic Hospital, Marseille, France
| | - Christian Piolat
- Department of Paediatric surgery, Grenoble Alpes University Hospital, Grenoble , France
| | - Frédéric Rongieras
- Department of Orthopaedics and Trauma, Edouard Herriot Hospital, Lyon, France
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery, APHP, Avicenne Academic Hospital, Sorbonne Paris Nord University, Bobigny France
| | - Paul Balandraud
- Department of General Surgery, Sainte-Anne Military Academic Hospital, Toulon, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| |
Collapse
|
3
|
Zhang KJ, Zhou H, Guo H, Li W, Yang Z, Liu R, Qin S, Xie X, Tian J. Learning and Short-Term Retention of Simulation-Based Arthroscopic Skills. JOURNAL OF SURGICAL EDUCATION 2023; 80:119-126. [PMID: 36137894 DOI: 10.1016/j.jsurg.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/09/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study aimed to examine the learning curve and short-term retention of arthroscopic skills acquired on a simulator. DESIGN Cohort study. SETTING Clinical Skills Training Center of Zhujiang Hospital of Southern Medical University PARTICIPANT AND METHODS: Orthopaedic residents (n = 14) without previous arthroscopy experience were included. After basic information was collected and an initial arthroscopy knowledge level test was administered, the subjects received standardised training on the simulator (day 1); then, they completed tasks on the simulator, including guided diagnostics (4 times), triangulation (5 times) and loose body removal (7 times). A learning curve for each skill was generated based on the total scores. The score of the last repetition of each task was the training level. RESULTS A total of 14 orthopedic residents were enrolled. All participants completed the training and testing. There was a learning curve over the course of training for all 3 arthroscopic skills (p < 0.001). On day 8 after the training, the mean score for guided diagnostics decreased from 49.9 to 48.9 (p = 0.001), and the retention rate was 97.8%. For triangulation, the mean total score decreased from 58.9 to 53.6 (p < 0.001), and the retention rate was 90.8%. For loose body removal, the mean total score decreased from 87.1 to 80.7 (p < 0.001), and the retention rate was 92.7%. CONCLUSIONS Orthopaedic residents' arthroscopic skills learned through simulator training declined significantly in 1 week after the training, especially more difficult skills.
Collapse
Affiliation(s)
- Kai-Jun Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haixia Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haopeng Guo
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhouwen Yang
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rubing Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shanlu Qin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaobo Xie
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Tian
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| |
Collapse
|
4
|
Defining operative experience targets in surgical training: A systematic review. Surgery 2022; 172:1364-1372. [PMID: 36038374 DOI: 10.1016/j.surg.2022.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/07/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to critique the available evidence regarding the relationship between operative experience in surgical training and trainee competence. METHODS A systematic review of the PubMed, Embase, Web of Science, and Cochrane library databases was conducted in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses guidelines. Articles were sought that defined the relationship between procedural volume in surgical training and trainee competence, proficiency, or mastery. The educational impact of included studies was evaluated using a modified Kirkpatrick model. RESULTS Of 3,672 records identified on database searching, 30 papers were ultimately included. Fourteen studies defined operative experience thresholds using operative time as a surrogate measure of competence, whereas another 8 used trainer assessments of operative performance (Kirkpatrick level 3). A further 5 studies were able to determine the relationship between trainee case volumes and subsequent patient outcomes (Kirkpatrick level 4b). CONCLUSION Many studies have recorded competent trainee performance in key index procedures after reaching experience threshold numbers in excess of currently mandated targets across jurisdictions. The evidence relating current operative experience targets to patient outcomes across a range of surgical subspecialties of surgical subspecialties is lacking. This review supports a move toward criterion-based referencing of operative performance targets in surgical training.
Collapse
|
5
|
Assessing Operative Skill in the Competency-based Education Era: Lessons From the UK and Ireland. Ann Surg 2022; 275:e615-e625. [PMID: 35129531 DOI: 10.1097/sla.0000000000005242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Decisions regarding the operative competence of surgical residents in the United Kingdom and Ireland are informed by operative workplace-based assessments (WBAs) and operative number targets for index procedures. This review seeks to outline the validity evidence of these assessment methods. METHODS A review of the MEDLINE (Pubmed), EMBASE and Cochrane Library databases was undertaken in accordance with the Joanna Briggs Institute Protocol for Scoping Reviews (2020). Articles were included if they provided evidence of the validity of procedure-based assessments, direct observation of procedural skills, or indicative operative number targets. The educational impact of each article was evaluated using a modified Kirkpatrick model. RESULTS Twenty-eight articles outlining validity evidence of WBAs and operative number targets were synthesised by narrative review. Five studies documented users' views on current assessment methods (Kirkpatrick level 1). Two articles recorded changes in attitudes towards current operative assessments (level 2a). Ten studies documented the ability of current assessments to record improvements in operative competence (level 2b). Ten studies measured a change in behaviour as a result of the introduction of these assessments (level 3). One article studied the ability of operative assessments to predict clinical outcomes (level 4b). CONCLUSIONS Operative WBAs are reliable. Scores achieved correlate with both time spent in training and recorded operative experience. Trainers and residents have concerns regarding the subjectivity of these assessments and the opportunistic nature in which they are used. Operative number targets are not criterion-referenced, lack validity evidence, and may be set too low to ensure operative competence.
Collapse
|
6
|
Myers TG, Marsh JL, Nicandri G, Gorczyca J, Pellegrini VD. Contemporary Issues in the Acquisition of Orthopaedic Surgical Skills During Residency: Competency-Based Medical Education and Simulation. J Bone Joint Surg Am 2022; 104:79-91. [PMID: 34752441 DOI: 10.2106/jbjs.20.01553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Orthopaedic education should produce surgeons who are competent to function independently and can obtain and maintain board certification. ➤ Contemporary orthopaedic training programs exist within a fixed 5-year time frame, which may not be a perfect match for each trainee. ➤ Most modern orthopaedic residencies have not yet fully adopted objective, proficiency-based, surgical skill training methods despite nearly 2 decades of evidence supporting the use of this methodology. ➤ Competency-based medical education backed by surgical simulation rooted in proficiency-based progression has the potential to address surgical skill acquisition challenges in orthopaedic surgery.
Collapse
Affiliation(s)
- Thomas G Myers
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | | | - Gregg Nicandri
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - John Gorczyca
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - Vincent D Pellegrini
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
7
|
Ludwig J, Jakobsen RB, Charles YP, Seifert J, Incoll I, Wood ML, Parmar D, Canter R. What it takes to become an orthopaedic surgeon: A comparison of orthopaedic surgical training programmes in 10 countries focusing on structure and fellowship requirements. Int J Surg 2021; 95:106150. [PMID: 34715383 DOI: 10.1016/j.ijsu.2021.106150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/28/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of surgical training has been highlighted as one of the most important patient safety issues in the future. Training surgeons and supporting them to do their best should be considered integral in providing optimum and safe care for the individual patient and the best possible return on investment in training medical professionals. In 2011, an international consensus statement defined fundamental principles for surgical training. PURPOSE This study examines orthopaedic surgical training to explore the similarities and differences in the requirements for trainees to obtain board certification in ten countries. METHODS Countries of the Commonwealth Health Care Comparison: Canada, the United Kingdom, the United States of America, Australia, New Zealand, Germany, France, the Netherlands, Norway and Switzerland were chosen to be compared. The relevant information was extracted from official information from authorities and administrative bodies. RESULTS The study revealed significant differences in duration, organisation and assessment of training. So-called "competency-based" training is not featured in every country, and the manner of its implementation is variable. In particular, the numbers in surgical cases required to be accredited varies by country ranging from 1260 (UK) to 340 (Norway). CONCLUSION Despite the recommendation in 2011 for some degree of uniformity across surgical training in industrialised countries, evidence suggests wide variation in the training programmes which is likely to be a concern in both quality of training as well as present and future patient safety.
Collapse
Affiliation(s)
- Johanna Ludwig
- BG Klinikum, Unfallkrankenhaus Berlin, Germany Kellogg College, University of Oxford, Oxford, United Kingdom Department of orthopedic surgery, Department of Health Management and Health Economics, Akershus University hospital and Institute of Health and Society, University Oslo, OSLO, Norway Hôpitaux Universitaires de Strasbourg, Department of Spine Surgery, Faculté de Médecine, Université de Strasbourg, France Department of Traumatology, University medicine, Universitätsmedizin Greifswald, University Greifswald, Greifswald, Germany University of Newcastle, District Clinical Director of Surgery; Clinical Lead, Quality & Innovation - Central Coast Local Health District, Graduate Programs in Surgical Education -University of Melbourne, Australia Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Tahir M, Rahman U, Gulati A. An international comparison of competency-based orthopaedic curricula and minimum operative experience - Review article. Int J Surg 2021; 94:106125. [PMID: 34592430 DOI: 10.1016/j.ijsu.2021.106125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/18/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Orthopaedic training has undergone considerable changes in the last few decades. Although structured training pathways exist in most countries, the requirements for completion of training are remarkably different. This review aims to assess key differences among orthopaedic curricula in selected high-income countries with well-established orthopaedic training programmes, focusing on their criteria for assessing technical competence prior to completion of training. METHODS Current orthopaedic training curricula published by the relevant accrediting bodies in the UK, USA, Canada, Australia, Germany and the European Union were reviewed. Data extracted included specified training duration, minimum or desirable operative experience requirements, methods and timing of in-training assessments. RESULTS The overall training duration ranged between 9 and 10 years in the UK and Australia, compared to 5-6 years in all other countries. While operative logbook was an essential component of formative and end-of-training reviews in all countries, minimum indicative numbers in index operations were a requirement only in the UK (minimum total required; 1800, index operations; 365) and USA (minimum total required; 1000, index operations; 455). On average, USA residents performed 1700 procedures compared to German residents performing 730 procedures before completion of training. CONCLUSION There is a lack of robust data describing the operative experiences of orthopaedic trainees outside of the UK and USA. UK training is the longest among countries compared in this review and also sets the highest standards in minimum operative experience requirements. Based on the evidence available, surgeons exiting training and entering independent practice in the above countries are not trained to the same minimum standard.
Collapse
Affiliation(s)
- Muaaz Tahir
- Trauma & Orthopaedics, The Royal Orthopaedic Hospital NHS Trust, Birmingham, UK University Hospitals Birmingham, Birmingham, UK Sandwell & West Birmingham Hospitals, Birmingham, UK
| | | | | |
Collapse
|