Jain Nickul S, Schwarzkopf Ran, Scolaro John A
Department of Orthopaedic Surgery, University of California, Irvine, Orange, California.
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York.
J Surg Educ. 2017 Jul-Aug;74(4):663-667. doi: 10.1016/j.jsurg.2017.01.003. Epub 2017 Jan 30.
Orthopedic residents commonly perform closed manipulative reductions as a part of their training. Traditionally, this skill is taught early in training but difficult to simulate. Proficiency is achieved through repetition and experience; faculty observation and instruction is unfortunately often limited. Direct resident teaching has been shown to increase competency, comfort, and long-term skill retention. We hypothesize that video review of closed fracture reductions will provide an inexpensive and valuable tool for resident education and improve skill performance.
Closed reductions performed by orthopaedic residents were recorded using a secured mobile tablet device in the emergency department (ED). Video review sessions were performed with both peer and faculty feedback/analysis of reduction technique. Anonymous resident and faculty surveys were completed following each session to evaluate the usage and perceived benefit of the program.
University-based Level I Trauma Center.
Orthopedic surgery residents and faculty.
All junior orthopedic residents (postgraduate year [PGY] 1-3) reported that direct video observation by faculty was beneficial. Furthermore, 97% of junior resident and 100% of faculty responses reported that they would use this educational technology in the future. Residents and faculty both strongly agreed that video review was more useful than other methods, improved resident preparation for ED fracture care, and felt this technique would improve patient care and outcomes. Compared with senior residents (PGY 4-5), PGY-1s believed that this technique helped them prepare for ED fracture care (p = 0.02).
Video review provides a useful, innovative, and inexpensive method to improve resident competency in closed fracture reduction-a critical skill in orthopedic patient care. These procedures are uncommonly available for direct faculty observation. We have demonstrated that both residents and faculty were satisfied with the ability to review procedures, identify weaknesses, and obtain or provide direct feedback on this skill. Additionally, fracture reduction video review may help residents meet and achieve clinical milestones, an area of future investigation.
骨科住院医师在培训过程中通常会进行闭合手法复位。传统上，这项技能在培训早期就会传授，但难以模拟。熟练程度是通过反复练习和经验积累获得的；不幸的是，教员的观察和指导往往有限。直接对住院医师进行教学已被证明可以提高能力、舒适度和长期技能保持。我们假设，对闭合性骨折复位的视频回顾将为住院医师教育提供一种廉价且有价值的工具，并提高技能表现。
骨科住院医师在急诊科使用安全的移动平板设备记录闭合性骨折复位操作。视频回顾环节包括同伴以及教员对复位技术的反馈/分析。每次课后，住院医师和教员完成匿名调查，以评估该项目的使用情况和感知到的益处。
大学附属一级创伤中心。
骨科住院医师和教员。
所有初级骨科住院医师（研究生一年级至三年级）均表示教员直接进行视频观察很有帮助。此外，97%的初级住院医师和100%的教员反馈表示他们未来会使用这种教育技术。住院医师和教员都强烈认为视频回顾比其他方法更有用，改善了住院医师对急诊科骨折护理的准备情况，并认为这项技术将改善患者护理和治疗结果。与高级住院医师（研究生四年级至五年级）相比，研究生一年级住院医师认为这项技术有助于他们为急诊科骨折护理做好准备（p = 0.02）。
视频回顾提供了一种有用、创新且廉价的方法来提高住院医师闭合性骨折复位的能力，这是骨科患者护理中的一项关键技能。这些操作很少有机会让教员直接观察。我们已经证明，住院医师和教员对回顾操作、识别弱点以及就这项技能获得或提供直接反馈的能力都很满意。此外，骨折复位视频回顾可能有助于住院医师达到并实现临床里程碑，这是未来研究的一个领域。
