From Mount Sinai Hospital, Toronto, Ont. (Dwyer, Theodoropoulos); Toronto Western Hospital, Toronto, Ont. (Chahal, Ogilvie-Harris); and Women’s College Hospital, Toronto, Ont. (Dwyer, Chahal, Murnaghan, Theodoropoulos, Cheung, McParland, Ogilvie-Harris).
Can J Surg. 2020 Mar 6;63(2):E110-E117. doi: 10.1503/cjs.015418.
The purpose of this study was to develop a multifaceted examination to assess the competence of fellows following completion of a sports medicine fellowship.
Orthopedic sports medicine fellows over 2 academic years were invited to participate in the study. Clinical skills were evaluated with objective structured clinical examinations, multiple-choice question examinations, an in-training evaluation report and a surgical logbook. Fellows’ performance of 3 technical procedures was assessed both intraoperatively and on cadavers: anterior cruciate ligament reconstruction (ACLR), arthroscopic rotator cuff repair (RCR) and arthroscopic shoulder Bankart repair. Technical procedural skills were assessed using previously validated task-specific checklists and the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale.
Over 2 years, 12 fellows were assessed. The Cronbach α for the technical assessments was greater than 0.8, and the interrater reliability for the cadaveric assessments was greater than 0.78, indicating satisfactory reliability. When assessed in the operating room, all fellows were determined to have achieved a minimal level of competence in the 3 surgical procedures, with the exception of 1 fellow who was not able achieve competence in ACLR. When their performance on cadaveric specimens was assessed, 2 of 12 (17%) fellows were not able to demonstrate a minimal level of competence in ACLR, 2 of 10 (20%) were not able to demonstrate a minimal level of competence for RCR and 3 of 10 (30%) were not able to demonstrate a minimal level of competence for Bankart repair.
There was a disparity between fellows’ performance in the operating room and their performance in the high-fidelity cadaveric setting, suggesting that technical performance in the operating room may not be the most appropriate measure for assessment of fellows’ competence.
本研究旨在开发一种多方面的考核，以评估完成运动医学 fellowship后的住院医师的能力。
邀请 2 个学年的骨科运动医学住院医师参与研究。临床技能通过客观结构化临床考试、多项选择题考试、培训评估报告和手术日志进行评估。住院医师对 3 种技术操作的表现进行了评估：前交叉韧带重建（ACLR）、关节镜肩袖修复（RCR）和关节镜Bankart 修复。使用先前验证的任务特定检查表和关节镜手术技能评估工具（ASSET）整体评分量表评估技术操作技能。
在 2 年期间，评估了 12 名住院医师。技术评估的 Cronbach α 大于 0.8，尸体评估的组内相关系数大于 0.78，表明可靠性令人满意。当在手术室进行评估时，除了 1 名住院医师未能在 ACLR 中达到胜任水平外，所有住院医师均被确定在 3 种手术中达到了最低水平的胜任能力。当对尸体标本的表现进行评估时，12 名住院医师中有 2 名（17%）未能在 ACLR 中展示最低水平的胜任能力，10 名住院医师中有 2 名（20%）未能在 RCR 中展示最低水平的胜任能力，10 名住院医师中有 3 名（30%）未能在 Bankart 修复中展示最低水平的胜任能力。
住院医师在手术室的表现与在高保真尸体环境中的表现存在差异，这表明手术室中的技术表现可能不是评估住院医师能力的最合适指标。
