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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.
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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
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Filliquist B, Kapatkin AS, Vernau KM, Nakatani JY, Chou PY, Ilkiw JE. Training Surgical Residents Utilizing an Animal Shelter Fracture Program. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:778-784. [PMID: 34779752 DOI: 10.3138/jvme-2021-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Working relationships between veterinary medical teaching hospitals, animal shelters, and rescue groups are one way to increase veterinary students' and residents' hands-on training. The goal of this study is to describe the use of a shelter fracture program to improve the surgical skills of surgical residents. In this program, the participating shelter and rescue organizations electronically submit cases. Following evaluation of radiographs and case approval by the orthopedic faculty, the case is scheduled for a physical evaluation. A resident takes primary surgical care together with a fourth-year student rotating through the orthopedic surgery service to ensure the proper pre-, peri-, and post-operative standard of care. All care is overseen by the orthopedic faculty. A veterinary student-run fracture foster program allows students to gain additional experience in the pre-, peri-, and post-operative care of shelter animals. The total number of shelter animals treated during a 9-year period was 373, with a mean annual case load of 41.1 cases (± 10.3). During the same time period, a total of 435 client-owned cases underwent surgical fracture treatment, with a mean annual case load of 48 cases (± 11.7). Surgical resident and student surveys show that this program contributes to their knowledge, skills, and confidence in treating fracture patients. A successful cooperative program provides advanced surgical fracture treatment of shelter animals, improving animals' quality of life as well as surgical residents' and veterinary students' skills training.
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Van Heest AE, Armstrong AD, Bednar MS, Carpenter JE, Garvin KL, Harrast JJ, Martin DF, Murray PM, Peabody TD, Saltzman CL, Saniei M, Taitsman LA, Marsh JL. American Board of Orthopaedic Surgery’s Initiatives Toward Competency-Based Education. JB JS Open Access 2022; 7:JBJSOA-D-21-00150. [PMID: 35620526 PMCID: PMC9119638 DOI: 10.2106/jbjs.oa.21.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The American Board of Orthopaedic Surgery (ABOS) is the national organization charged with defining education standards for graduate medical education in orthopaedic surgery. The purpose of this article is to describe initiatives taken by the ABOS to develop assessments of competency of residents to document their progress toward the independent practice of orthopaedic surgery and provide feedback for improved performance during training. These initiatives are called the ABOS Knowledge, Skills, and Behavior Program. Web-based assessment tools have been developed and validated to measure competence. These assessments guide resident progress through residency education and better define the competency level by the end of training. The background and rationale for these initiatives and how they serve as steps toward competency-based education in orthopaedic residency education in the United States will be reviewed with a vision of a hybrid of time and competency-based orthopaedic residency education that will remain 5 years in length, with residents assessed using standardized tools.
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Affiliation(s)
- Ann E. Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
- E-mail address for A.E. Van Heest:
| | - April D. Armstrong
- Department of Orthopaedics and Rehabilitation, Bone, and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael S. Bednar
- Department of Orthopaedic Surgery and Rehabilitations, Loyola University Medical Center, Chicago, Illinois
| | - James E. Carpenter
- Department of Orthopaedic Surgery, Sports Medicine, Med Sport, Ann Arbor, Michigan
| | - Kevin L. Garvin
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - David F. Martin
- American Board of Orthopaedic Surgery, Chapel Hill, North Carolina
| | - Peter M. Murray
- Department of Orthopaedic Surgery and Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Terrance D. Peabody
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | | | - Mona Saniei
- American Board of Orthopaedic Surgery, Chapel Hill, North Carolina
| | - Lisa A. Taitsman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle Washington
| | - J. Lawrence Marsh
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa
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Levidy MF, Dobitsch A, Luis J, Fano AN, Para A, Vosbikian M, Beebe K, Kaushal N. A Review of Orthopaedic Resident Case Logs to Identify Fluctuations in Exposure to Adult Orthopaedic Procedures. JB JS Open Access 2021; 6:e21.00023. [PMID: 34514284 PMCID: PMC8423386 DOI: 10.2106/jbjs.oa.21.00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Orthopaedic surgery resident case exposure is an important component of surgical training and is monitored by the Accreditation Council for Graduate Medical Education (ACGME) to ensure resident readiness for graduation. The purpose of this study was to investigate trends in exposure to adult orthopaedic surgical procedures and analyze the impact of the 2013 update in ACGME case logging expectations. METHODS A retrospective review of ACGME case log data was conducted for adult orthopaedic procedures performed by graduating orthopaedic surgery residents from 2012 to 2020. Trends in the number of cases logged and the case share by anatomical location were investigated. Linear regression analysis was performed to analyze changes in case number over the 9-year period. RESULTS For all surgical categories, there was stability in the average case number per resident from 2012 to 2013, followed by a precipitous decrease from 2013 to 2014. From 2014 to 2020, there has been a gradual increase in case number for all categories except "other musculoskeletal (MSK)," resulting in a total 46% recovery since the 2014 decline. Concomitant with the decline, there was a relative increase in pelvis/hip and femur/knee procedures and decrease in shoulder, other MSK, and spine procedures. From 2014 to 2020, shoulder, humerus/elbow, pelvis/hip, leg/ankle, foot/toes, and spine cases have gradually accounted for a larger proportion of total cases while femur/knee and "other MSK" cases have accounted for less. CONCLUSIONS The 2013 update in ACGME case logging expectations was associated with a significant decrease in case number. This is likely a reflection of residents correctly entering 1 primary Current Procedural Terminology code for each surgical case. Programs should be aware of a general increase in case number since 2014 and acknowledge the fact that some procedure types may be given priority from a logging standpoint when multiple Current Procedural Terminology codes apply.
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Affiliation(s)
| | | | - Justin Luis
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Adam N. Fano
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ashok Para
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael Vosbikian
- Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Kathleen Beebe
- Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Neil Kaushal
- Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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McDonald TC, Drake LC, Replogle WH, Graves ML, Brooks JT. Barriers to Increasing Diversity in Orthopaedics: The Residency Program Perspective. JB JS Open Access 2020; 5:JBJSOA-D-20-00007. [PMID: 32832828 PMCID: PMC7418923 DOI: 10.2106/jbjs.oa.20.00007] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: There are little data to explain why the surgical subspecialty of orthopaedic
surgery struggles with improving the racial/ethnic composition of its
workforce. The current work sought to determine what orthopaedic residency
program directors and coordinators believe are the barriers to improving
diversity at their own programs. Methods: Between November 17, 2018, and April 1, 2019, a 17-question survey was
electronically distributed to the program directors and coordinators of 155
allopathic orthopaedic surgery residency programs. Seventy-five of 155
programs (48.4%) responded to the survey. A p-value of < 0.05 was used
to determine statistical significance. Results: The most commonly stated barriers to increasing diversity within the
orthopaedic surgery programs were the following: “We do not have
enough minority faculty, which may deter the applicants” (69.3%),
“We consistently rank minority applicants high but can never seem to
match them” (56%), and “Not enough minorities are applying to
our program” (54.7%). Programs with higher percentages of
underrepresented minority (URM) faculty had higher percentages of URM
residents (p = 0.001). Programs participating in the Nth Dimensions
and/or Perry Initiative programs had a higher percentage of URM faculty as
compared to the residency programs that did not participate in these
programs (p = 0.004). URM residents represented 17.5% of all residents
who resigned and/or were dismissed in the 10 years preceding the survey
while also only representing 6% of all orthopaedic residents during the same
time period. Conclusions: From the orthopaedic residency program perspective, the greatest perceived
barrier to increasing the racial/ethnic diversity of residents in their
program is their lack of URM faculty. Surveyed programs with more URM
faculty had more URM residents, and programs participating in Nth Dimensions
and/or Perry Initiative programs had a higher percentage of URM faculty.
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Affiliation(s)
- Tyler C McDonald
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi
| | - Luke C Drake
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi
| | - William H Replogle
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi
| | - Matthew L Graves
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jaysson T Brooks
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi
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Kohring JM, Harrast JJ, Stotts AK, Zhang C, Millar MM, Presson AP, Saltzman CL. Resident Independence Performing Common Orthopaedic Procedures at the End of Training: Perspective of the Graduated Resident. J Bone Joint Surg Am 2020; 102:e2. [PMID: 31567668 DOI: 10.2106/jbjs.18.01469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) has established minimum exposure rates for specific orthopaedic procedures during residency but has not established the achievement of competence at the end of training. The determination of independence performing surgical procedures remains undefined and may depend on the perspective of the observer. The purpose of this study was to understand the perceptions of recently graduated orthopaedic residents on the number of cases needed to achieve independence and on the ability to perform common orthopaedic procedures at the end of training. METHODS We conducted a web survey of all 727 recently graduated U.S. orthopaedic residents sitting for the 2018 American Board of Orthopaedic Surgery Part I Examination in July 2018. The surveyed participants were asked to assess the ability to independently perform 26 common adult and pediatric orthopaedic procedures as well as to recommend the number of cases to achieve independence at the end of training. We compared these data to the ACGME Minimum Numbers and the average ACGME resident experience data for residents who graduated from 2010 to 2012. RESULTS For 14 (78%) of the 18 adult procedures, >80% of respondents reported the ability to perform independently, and for 7 (88%) of the 8 pediatric procedures, >90% reported the ability to perform independently. The resident-recommended number of cases for independence was greater than the ACGME Minimum Numbers for all but 1 adult procedure. For 18 of the 26 adult and pediatric procedures, the mean 2010 to 2012 graduated resident exposure was significantly less than the mean number recommended for independence by 2018 graduates (p < 0.05). CONCLUSIONS Overall, recently graduated residents reported high self-perceived independence in performing the majority of the common adult and pediatric orthopaedic surgical procedures included in this study. In general, recently graduated residents recommended a greater number of case exposures to achieve independence than the ACGME Minimum Numbers.
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Affiliation(s)
- Jessica M Kohring
- Departments of Orthopaedics (J.M.K., A.K.S., A.P.P., and C.L.S.) and Internal Medicine (C.Z., M.M.M., and A.P.P.), University of Utah, Salt Lake City, Utah
| | | | - Alan K Stotts
- Departments of Orthopaedics (J.M.K., A.K.S., A.P.P., and C.L.S.) and Internal Medicine (C.Z., M.M.M., and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Departments of Orthopaedics (J.M.K., A.K.S., A.P.P., and C.L.S.) and Internal Medicine (C.Z., M.M.M., and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Morgan M Millar
- Departments of Orthopaedics (J.M.K., A.K.S., A.P.P., and C.L.S.) and Internal Medicine (C.Z., M.M.M., and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Departments of Orthopaedics (J.M.K., A.K.S., A.P.P., and C.L.S.) and Internal Medicine (C.Z., M.M.M., and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Charles L Saltzman
- Departments of Orthopaedics (J.M.K., A.K.S., A.P.P., and C.L.S.) and Internal Medicine (C.Z., M.M.M., and A.P.P.), University of Utah, Salt Lake City, Utah
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