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Competency-Based Medical Education: Use of an Objective Structured Assessment of Technical Skill (OSATS) after an Orthopaedic Sports Medicine Rotation
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ABSTRACTS
matched controls. This information can be used to counsel this difficult patient population on expected outcomes following arthroplasty procedures.
Fixation of a collagen patch in the porcine knee: Implications for MACI and second-generation ACI SS-60 Saturday, April 25 at 1:20 PM LAITH JAZRAWI, M.D., PRESENTING AUTHOR GRAEME WHYTE, M.D. ALAN MCGEE, M.D. ROBERT MEISLIN, M.D. Introduction: Type I/III collagen patches are routinely used for second-generation autologous chondrocyte implantation (ACI) procedures. The purpose of this study is to evaluate the stability of type I/III collagen patch fixation to a porcine medial femoral condyle. Methods: A total of 24 fresh cadaveric porcine knee specimens underwent a medial parapatellar arthrotomy. A prefabricated template was used to create standardized chondral defects of 2cm2 in the medial femoral condyle. A template was used to fashion a 2cm2 type I/III collagen patch. Four methods of fixation of the patch were analyzed: Group I e saline alone, Group II e fibrin glue around edge of collagen patch, Group III e fibrin glue in base of defect and around edge of collagen patch, Group IV e circumferential 6-0 vicryl suture and glue around edge of collagen patch. Each knee underwent 1200 cycles from full extension to 90 degrees flexion. Patch fixation was assessed at intervals of 60, 300, 600, 900, and 1200 cycles. Results: There were no complete failures of collagen patch fixation after 1200 cycles in the control or experimental groups. No partial loss of patch fixation occurred in the glue with suture group. Partial loss of fixation and defect exposure occurred in groups with glue fixation and the group with saline fixation of the collagen patch. Nearcomplete failure of patch fixation occurred in one specimen secured with glue alone. Conclusion: Suture fixation in addition to fibrin glue of a collagen patch in a chondral defect provides improved fixation and resistance to deformation compared to saline or fibrin glue alone. Near-complete failure of fixation of a collagen patch secured with fibrin glue alone suggests that this technique may benefit from supplemental fixation. To ensure adequate security of fixation of a collagen patch to a chondral defect of the femoral condyle, sutures should be used.
Ankle Arthroscopy Simulation Improves Basic Skills, Anatomic Recognition and Proficiency during Diagnostic examination of Residents in Training SS-61 Saturday, April 25 at 1:55 PM KEVIN MARTIN, D.O., PRESENTING AUTHOR DAVID PATTERSON, M.D. PHINIT PHISITKUL, M.D. KENNETH CAMERON, PH.D., M.P.H.
JOHN FEMINO, M.D. ANNUNZIATO AMENDOLA, M.D. Introduction: The Purpose of this study was to determine whether low fidelity arthroscopic simulation training improves basic ankle arthroscopy performance and efficiency among orthopaedic trainees. Methods: Thirty orthopaedic surgery trainees with varying levels of ankle arthroscopy experience were randomized into either a simulation or standard practice groups. All subjects were oriented to the arthroscopic Sawbones ankle simulator, a 15-point ankle arthroscopy checklist, and the Arthroscopic Surgery Skill Evaluation Tool (ASSET), a validated metric for assessing technical ability during arthroscopy. Individual surgical case logs were queried to identify cumulative exposure to ankle arthroscopy. At baseline testing, all participants performed simulator-based testing and a cadaveric diagnostic ankle arthroscopy with video recording. The simulation group subsequently received four one-onone 15 minute training sessions over a four-month period, while the standard practice group received routine arthroscopic exposure without simulator training. After intervention, both groups were re-evaluated with simulator testing and a second recorded cadaveric diagnostic ankle arthroscopy. Two blinded, independent experts evaluated each arthroscopic performance utilizing the 15-point checklist, ASSET score, and total elapsed time, and all outcome measures were compared within and between groups. Results: Baseline arthroscopic experience, simulator task performance measures, and ASSET scores were equivalent between the simulation and standard practice groups. After completion of training the simulation group outscored the control group in total ASSET score (34.93 to 19.63. Conclusion: These results demonstrate low fidelity ankle arthroscopy simulation training can improve orthopaedic trainees’ basic surgical skills, efficiency of movement an anatomic recognition. The results also suggest greater patient safety during ankle arthroscopy following simulation training.
Competency-Based Medical Education: Use of an Objective Structured Assessment of Technical Skill (OSATS) after an Orthopaedic Sports Medicine Rotation SS-62 Saturday, April 25 at 2:00 PM JESSE SLADE SHANTZ, M.D., PRESENTING AUTHOR TIM DWYER, M.B.B.S., F.R.A.C.S., F.R.C.S.C. JASKARNDIP CHAHAL, M.D., M.SC., F.R.C.S.C. DAVID WASSERSTEIN, M.D. RACHEL SCHACHAR, M.D. BRIAN DEVITT, M.D. JOHN THEODOROPOULOS, M.D., F.R.C.S.C. CHARLOTTE RINGSTED, M.D., M.H.P.E., PH.D. BRIAN HODGES, M.D., M.ED., F.R.C.P.C., PH.D. DARRELL OGILVIE-HARRIS, M.D., F.R.C.S.C.
ABSTRACTS
Introduction: The introduction of Competency Based Medical Education (CBME) in orthopaedics at the University of Toronto demands validated methods of evaluation, especially in technical skill. We hypothesized that a multi-station Objective Structured Assessment of Technical Skill (OSATS) would be a valid and reliable method of assessing resident competence in surgical skill after a sports medicine rotation. Methods: At the start of their three-month sports medicine rotation, each resident was provided a list of 10 surgical skills in which they were expected to demonstrate competence (Table 1). At the end of the rotation, each resident undertook an OSATS comprised of six randomly chosen stations. Low-fidelity sawbones models were used in all stations. Residents were evaluated by staff surgeons using a previously validated global rating scale (ASSET), task-specific checklists created using a modified Delphi procedure, and a final five-point rating using the Drefus model of skill acquisition. Results: Over 18 months, 27 residents (19 junior, 8 senior) sat the OSATS after their rotation, as well as 14 sports medicine staff and fellows. The overall reliability of the OSATS was 0.97. A significant difference by year in training was seen for the overall global rating (p<0.05). Conclusion: The use of low-fidelity sawbones models is a valid and reliable method of assessing surgical skills in orthopaedic residents after a sports medicine rotation. On this OSATS, junior residents were not able to perform technical skills as well as senior residents. This research suggests that despite intensive teaching within a CBME model, overall surgical experience is crucial to the acquisition of technical skills within a rotation. Can Arthroscopic Training Courses Improve Residents Arthroscopic Basic Skills? A Simulation based Prospective Control Trial SS-63 Saturday, April 25 at 2:05 PM KEVIN MARTIN, D.O., PRESENTING AUTHOR DAVID PATTERSON, M.D. KENNETH CAMERON, PH.D., M.P.H. ROBERT PEDOWITZ, M.D., PH.D. Introduction: Resident education continues to progress towards a proficiency based curriculum that can be standardized and reproduced. Arthroscopy education has been a major focus due to its popularity and reproducibility but it has lacked a validated standardized curriculum. Many organizations and private industry host multi day arthroscopic educational course and none have objectively evaluated there outcomes nor standardized their curriculums. Our goal was to evaluate the correlation between timed task performance on an arthroscopic shoulder simulator and participation in a well-established standardized arthroscopic educational course. Methods: 48 orthopaedic residents were voluntarily recruited from over 25 programs throughout the United States and Canada. Each subject was tested upon arrival at the North American Arthroscopic Association (AANA) orthopaedic learning center on an virtual reality
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arthroscopic shoulder simulator and objectively scored. Each subjects total number of shoulder arthroscopies and PGY were also evaluated to establish surgical experience using each subjects mandated ACGME or equivalent case log system. Following the intense 4 day training curriculum each resident was reevaluated on the same simulator. A multivariate regression analysis was performed to determine the correlation between simulator performance and participation in the training program. Results: After completing the four day standardized arthroscopic curriculum subjects demonstrated significant improvements in all dimensions measured by the simulator. The subjects significantly decreased there probe distance traveled representing improved instrument handling. The subjects all significantly decreased camera distance traveled representing improved anatomic recognition and familiarization. Finally subjects time to completion also significantly improved, time alone does not represent improvement in skill but when combined with the other outcome measures it does reflect improved overall proficiency. Conclusion: This study establishes objective improvement in orthopaedic trainee’s basic arthroscopic skills following a standardized 4 day arthroscopic training curriculum. This data also objectively validates the North American Association of Arthroscopy resident training course and curriculum. Open-Access Video-Based Orthopaedic tional Content is Inconsistent SS-64 Saturday, April 25 at 2:10 PM EKATERINA URCH, M.D., PRESENTING AUTHOR SAMUEL TAYLOR, M.D. ELIZABETH CODY, M.D. PETER FABRICANT, M.D., M.P.H. JAYME BURKET KOLTSOV, PH.D. STEPHEN O’BRIEN, M.D., M.B.A. DAVID DINES, M.D. JOSHUA DINES, M.D.
Instruc-
Introduction: The internet has an increasing role in both patient and physician education. While several recent studies critically appraised the quality and accuracy of web-based written information available to patients, no studies have evaluated such parameters for open access video content designed for provider use. The present study sought to determine utilization of video resources by orthopaedic residents and assess the quality and accuracy of their content. Methods: Surveys were distributed to orthopaedic surgery residents to to determine their use of open access instructional video content. An assessment of quality and accuracy of said video content was performed using the basic shoulder examination as a suragate for the “best-case scenario” due to its widely accepted components that are stable over time. Three search terms (“shoulder”, “examination” and “shoulder exam”) were entered into the four online video resources most commonly accessed by orthopaedic surgery residents (VuMedi, G9MD, Orthobullets, and YouTube). Videos were captured and independently reviewed by three orthopedic surgeons. Quality and accuracy were assessed in accordance with previously published standards.
ABSTRACTS
matched controls. This information can be used to counsel this difficult patient population on expected outcomes following arthroplasty procedures.
Fixation of a collagen patch in the porcine knee: Implications for MACI and second-generation ACI SS-60 Saturday, April 25 at 1:20 PM LAITH JAZRAWI, M.D., PRESENTING AUTHOR GRAEME WHYTE, M.D. ALAN MCGEE, M.D. ROBERT MEISLIN, M.D. Introduction: Type I/III collagen patches are routinely used for second-generation autologous chondrocyte implantation (ACI) procedures. The purpose of this study is to evaluate the stability of type I/III collagen patch fixation to a porcine medial femoral condyle. Methods: A total of 24 fresh cadaveric porcine knee specimens underwent a medial parapatellar arthrotomy. A prefabricated template was used to create standardized chondral defects of 2cm2 in the medial femoral condyle. A template was used to fashion a 2cm2 type I/III collagen patch. Four methods of fixation of the patch were analyzed: Group I e saline alone, Group II e fibrin glue around edge of collagen patch, Group III e fibrin glue in base of defect and around edge of collagen patch, Group IV e circumferential 6-0 vicryl suture and glue around edge of collagen patch. Each knee underwent 1200 cycles from full extension to 90 degrees flexion. Patch fixation was assessed at intervals of 60, 300, 600, 900, and 1200 cycles. Results: There were no complete failures of collagen patch fixation after 1200 cycles in the control or experimental groups. No partial loss of patch fixation occurred in the glue with suture group. Partial loss of fixation and defect exposure occurred in groups with glue fixation and the group with saline fixation of the collagen patch. Nearcomplete failure of patch fixation occurred in one specimen secured with glue alone. Conclusion: Suture fixation in addition to fibrin glue of a collagen patch in a chondral defect provides improved fixation and resistance to deformation compared to saline or fibrin glue alone. Near-complete failure of fixation of a collagen patch secured with fibrin glue alone suggests that this technique may benefit from supplemental fixation. To ensure adequate security of fixation of a collagen patch to a chondral defect of the femoral condyle, sutures should be used.
Ankle Arthroscopy Simulation Improves Basic Skills, Anatomic Recognition and Proficiency during Diagnostic examination of Residents in Training SS-61 Saturday, April 25 at 1:55 PM KEVIN MARTIN, D.O., PRESENTING AUTHOR DAVID PATTERSON, M.D. PHINIT PHISITKUL, M.D. KENNETH CAMERON, PH.D., M.P.H.
JOHN FEMINO, M.D. ANNUNZIATO AMENDOLA, M.D. Introduction: The Purpose of this study was to determine whether low fidelity arthroscopic simulation training improves basic ankle arthroscopy performance and efficiency among orthopaedic trainees. Methods: Thirty orthopaedic surgery trainees with varying levels of ankle arthroscopy experience were randomized into either a simulation or standard practice groups. All subjects were oriented to the arthroscopic Sawbones ankle simulator, a 15-point ankle arthroscopy checklist, and the Arthroscopic Surgery Skill Evaluation Tool (ASSET), a validated metric for assessing technical ability during arthroscopy. Individual surgical case logs were queried to identify cumulative exposure to ankle arthroscopy. At baseline testing, all participants performed simulator-based testing and a cadaveric diagnostic ankle arthroscopy with video recording. The simulation group subsequently received four one-onone 15 minute training sessions over a four-month period, while the standard practice group received routine arthroscopic exposure without simulator training. After intervention, both groups were re-evaluated with simulator testing and a second recorded cadaveric diagnostic ankle arthroscopy. Two blinded, independent experts evaluated each arthroscopic performance utilizing the 15-point checklist, ASSET score, and total elapsed time, and all outcome measures were compared within and between groups. Results: Baseline arthroscopic experience, simulator task performance measures, and ASSET scores were equivalent between the simulation and standard practice groups. After completion of training the simulation group outscored the control group in total ASSET score (34.93 to 19.63. Conclusion: These results demonstrate low fidelity ankle arthroscopy simulation training can improve orthopaedic trainees’ basic surgical skills, efficiency of movement an anatomic recognition. The results also suggest greater patient safety during ankle arthroscopy following simulation training.
Competency-Based Medical Education: Use of an Objective Structured Assessment of Technical Skill (OSATS) after an Orthopaedic Sports Medicine Rotation SS-62 Saturday, April 25 at 2:00 PM JESSE SLADE SHANTZ, M.D., PRESENTING AUTHOR TIM DWYER, M.B.B.S., F.R.A.C.S., F.R.C.S.C. JASKARNDIP CHAHAL, M.D., M.SC., F.R.C.S.C. DAVID WASSERSTEIN, M.D. RACHEL SCHACHAR, M.D. BRIAN DEVITT, M.D. JOHN THEODOROPOULOS, M.D., F.R.C.S.C. CHARLOTTE RINGSTED, M.D., M.H.P.E., PH.D. BRIAN HODGES, M.D., M.ED., F.R.C.P.C., PH.D. DARRELL OGILVIE-HARRIS, M.D., F.R.C.S.C.
ABSTRACTS
Introduction: The introduction of Competency Based Medical Education (CBME) in orthopaedics at the University of Toronto demands validated methods of evaluation, especially in technical skill. We hypothesized that a multi-station Objective Structured Assessment of Technical Skill (OSATS) would be a valid and reliable method of assessing resident competence in surgical skill after a sports medicine rotation. Methods: At the start of their three-month sports medicine rotation, each resident was provided a list of 10 surgical skills in which they were expected to demonstrate competence (Table 1). At the end of the rotation, each resident undertook an OSATS comprised of six randomly chosen stations. Low-fidelity sawbones models were used in all stations. Residents were evaluated by staff surgeons using a previously validated global rating scale (ASSET), task-specific checklists created using a modified Delphi procedure, and a final five-point rating using the Drefus model of skill acquisition. Results: Over 18 months, 27 residents (19 junior, 8 senior) sat the OSATS after their rotation, as well as 14 sports medicine staff and fellows. The overall reliability of the OSATS was 0.97. A significant difference by year in training was seen for the overall global rating (p<0.05). Conclusion: The use of low-fidelity sawbones models is a valid and reliable method of assessing surgical skills in orthopaedic residents after a sports medicine rotation. On this OSATS, junior residents were not able to perform technical skills as well as senior residents. This research suggests that despite intensive teaching within a CBME model, overall surgical experience is crucial to the acquisition of technical skills within a rotation. Can Arthroscopic Training Courses Improve Residents Arthroscopic Basic Skills? A Simulation based Prospective Control Trial SS-63 Saturday, April 25 at 2:05 PM KEVIN MARTIN, D.O., PRESENTING AUTHOR DAVID PATTERSON, M.D. KENNETH CAMERON, PH.D., M.P.H. ROBERT PEDOWITZ, M.D., PH.D. Introduction: Resident education continues to progress towards a proficiency based curriculum that can be standardized and reproduced. Arthroscopy education has been a major focus due to its popularity and reproducibility but it has lacked a validated standardized curriculum. Many organizations and private industry host multi day arthroscopic educational course and none have objectively evaluated there outcomes nor standardized their curriculums. Our goal was to evaluate the correlation between timed task performance on an arthroscopic shoulder simulator and participation in a well-established standardized arthroscopic educational course. Methods: 48 orthopaedic residents were voluntarily recruited from over 25 programs throughout the United States and Canada. Each subject was tested upon arrival at the North American Arthroscopic Association (AANA) orthopaedic learning center on an virtual reality
e25
arthroscopic shoulder simulator and objectively scored. Each subjects total number of shoulder arthroscopies and PGY were also evaluated to establish surgical experience using each subjects mandated ACGME or equivalent case log system. Following the intense 4 day training curriculum each resident was reevaluated on the same simulator. A multivariate regression analysis was performed to determine the correlation between simulator performance and participation in the training program. Results: After completing the four day standardized arthroscopic curriculum subjects demonstrated significant improvements in all dimensions measured by the simulator. The subjects significantly decreased there probe distance traveled representing improved instrument handling. The subjects all significantly decreased camera distance traveled representing improved anatomic recognition and familiarization. Finally subjects time to completion also significantly improved, time alone does not represent improvement in skill but when combined with the other outcome measures it does reflect improved overall proficiency. Conclusion: This study establishes objective improvement in orthopaedic trainee’s basic arthroscopic skills following a standardized 4 day arthroscopic training curriculum. This data also objectively validates the North American Association of Arthroscopy resident training course and curriculum. Open-Access Video-Based Orthopaedic tional Content is Inconsistent SS-64 Saturday, April 25 at 2:10 PM EKATERINA URCH, M.D., PRESENTING AUTHOR SAMUEL TAYLOR, M.D. ELIZABETH CODY, M.D. PETER FABRICANT, M.D., M.P.H. JAYME BURKET KOLTSOV, PH.D. STEPHEN O’BRIEN, M.D., M.B.A. DAVID DINES, M.D. JOSHUA DINES, M.D.
Instruc-
Introduction: The internet has an increasing role in both patient and physician education. While several recent studies critically appraised the quality and accuracy of web-based written information available to patients, no studies have evaluated such parameters for open access video content designed for provider use. The present study sought to determine utilization of video resources by orthopaedic residents and assess the quality and accuracy of their content. Methods: Surveys were distributed to orthopaedic surgery residents to to determine their use of open access instructional video content. An assessment of quality and accuracy of said video content was performed using the basic shoulder examination as a suragate for the “best-case scenario” due to its widely accepted components that are stable over time. Three search terms (“shoulder”, “examination” and “shoulder exam”) were entered into the four online video resources most commonly accessed by orthopaedic surgery residents (VuMedi, G9MD, Orthobullets, and YouTube). Videos were captured and independently reviewed by three orthopedic surgeons. Quality and accuracy were assessed in accordance with previously published standards.