Oxford Orthopaedic Simulation & Education Centre, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, England.
Arthroscopy. 2013 May;29(5):906-12. doi: 10.1016/j.arthro.2013.01.026.
To determine whether a global rating scale (GRS) with construct validity can also be used to assess the learning curve of individual orthopaedic trainees during simulated arthroscopic knee meniscal repair.
An established arthroscopic GRS was used to evaluate the technical skill of 19 orthopaedic residents performing a standardized arthroscopic meniscal repair in a bioskills laboratory. The residents had diagnostic knee arthroscopy experience but no experience with arthroscopic meniscal repair. Residents were videotaped performing an arthroscopic meniscal repair on 12 separate occasions. Their performance was assessed by use of the GRS and motion analysis objectively measuring the time taken to complete tasks, path length of the subject's hands, and number of hand movements. One author assessed all 228 videos, whereas 2 other authors rated 34 randomly selected videos, testing the interobserver reliability of the GRS. The validity of the GRS was tested against the motion analysis.
Objective assessment with motion analysis defined the surgeon's learning curve, showing significant improvement by each subject over 12 episodes (P < .0001). The GRS also showed a similar learning curve with significant improvements in performance (P < .0001). The median GRS score improved from 15 of 34 (interquartile range, 14 to 17) at baseline to 22 of 34 (interquartile range, 19 to 23) in the final period. There was a moderate correlation (P < .0001, Spearman test) between the GRS and motion analysis parameters (r = -0.58 for time, r = -0.58 for path length, and r = -0.51 for hand movements). The inter-rater reliability among 3 trained assessors using the GRS was excellent (Cronbach α = 0.88).
When compared with motion analysis, an established arthroscopic GRS, with construct validity, also offers a moderately feasible method to monitor the learning curve of individual residents during simulated knee meniscal repair.
An arthroscopic GRS can be used for monitoring skill improvement during knee meniscal repair and has the potential for use as a training and assessment tool in the real operating room.
确定具有构建效度的整体评分量表（GRS）是否也可用于评估在模拟关节镜下半月板修复过程中个体骨科住院医师的学习曲线。
使用已建立的关节镜 GRS 评估 19 名骨科住院医师在生物技能实验室进行标准化关节镜下半月板修复的技术技能。这些住院医师具有膝关节关节镜诊断经验，但没有关节镜下半月板修复经验。住院医师在 12 个不同的场合进行关节镜下半月板修复。使用 GRS 和客观测量任务完成时间、术者手部路径长度和手部运动次数的运动分析来评估他们的表现。一位作者评估了所有 228 个视频，而另外两位作者评估了随机选择的 34 个视频，以测试 GRS 的观察者间可靠性。通过与运动分析比较来测试 GRS 的有效性。
使用运动分析进行客观评估确定了外科医生的学习曲线，每个受试者在 12 个阶段中都有明显的进步（P <.0001）。GRS 也显示出类似的学习曲线，表现明显改善（P <.0001）。GRS 中位数评分从基线时的 34 分中的 15 分（四分位距，14 到 17）提高到最后阶段的 34 分中的 22 分（四分位距，19 到 23）。GRS 与运动分析参数之间存在中度相关性（P <.0001，Spearman 检验）（时间 r = -0.58，路径长度 r = -0.58，手部运动 r = -0.51）。使用 GRS 的 3 位训练有素的评估者之间的观察者间可靠性很高（Cronbach α = 0.88）。
与运动分析相比，具有构建效度的既定关节镜 GRS 也提供了一种在模拟膝关节半月板修复过程中监测个体住院医师学习曲线的可行方法。
关节镜 GRS 可用于监测膝关节半月板修复过程中的技能提高，并且有可能作为真实手术室内的培训和评估工具。
