ProOrtho Clinic (Emeritus), Kirkland, Washington, U.S.A..
Desert Orthopedic Center, Shoulder and Elbow Service, Palm Desert, California, U.S.A.
Arthroscopy. 2021 Apr;37(4):1099-1106.e5. doi: 10.1016/j.arthro.2020.11.040. Epub 2020 Dec 24.
To investigate the impact of a proficiency-based progression (PBP) curriculum employed to teach trainees in the skills needed to demonstrate proficiency for an arthroscopic Bankart repair (ABR) and an arthroscopic rotator cuff repair (ARCR) by objectively comparing pre- and immediate postcourse performances.
In a prospective study, 16 arthroscopy/sports medicine fellows and 2 senior residents (complete group: N = 18) were randomly assigned to perform a precourse cadaveric ABR (Bankart subgroup: N = 6), ARCR (cuff subgroup: N = 6), or basic skills on a shoulder simulator (N = 6). After completing a PBP training curriculum, all 18 registrants performed both an ABR and ARCR scored in real time by trained raters using previously validated metrics.
The Bankart subgroup made 58% fewer objectively assessed errors at the completion of the course than at baseline (P = .004, confidence interval -1.449 to -0.281), and performance variability was substantially reduced (standard deviation = 5.89 vs 2.81). The cuff subgroup also made 58% fewer errors (P = .001, confidence interval -1.376 to 0.382) and showed a similar reduction in performance variability (standard deviation = 5.42 vs 2.1). Only one subject's precourse baseline performance met the proficiency benchmark compared with 89% and 83% of the all registrants on the final ABR and ARCR cadaveric assessments, respectively.
The results of this study reject the null hypothesis. They demonstrate that the implementation of a PBP simulation curriculum to train the skills necessary to perform arthroscopic Bankart and rotator cuff repairs results in a large and statistically significant improvement in the trainee's ability to meet the 2 related performance benchmarks. Proficiency was demonstrated by 89% and 83% of the trainees for an ABR and an ARCR, respectively, in a two- and one-half day course.
Surgical training employing a PBP curriculum is efficient, effective, and has the potential to improve patient safety.
通过客观比较课程前后的表现，研究一种基于熟练程度的进阶课程（PBP）在教授关节镜下 Bankart 修复术（ABR）和关节镜下肩袖修复术（ARCR）所需技能方面对学员的影响。
在一项前瞻性研究中，16 名关节镜/运动医学研究员和 2 名高级住院医师（总组：N=18）被随机分配进行课前尸体 ABR（Bankart 亚组：N=6）、ARCR（肩袖亚组：N=6）或肩部模拟器上的基本技能（N=6）。完成 PBP 培训课程后，所有 18 名注册学员都使用之前经过验证的指标实时进行了 ABR 和 ARCR 的评分。
Bankart 亚组在课程结束时比基线时减少了 58%的客观评估错误（P=0.004，置信区间-1.449 至-0.281），且性能变异性显著降低（标准差=5.89 至 2.81）。肩袖亚组的错误也减少了 58%（P=0.001，置信区间-1.376 至 0.382），且性能变异性也有类似的降低（标准差=5.42 至 2.1）。与最终的尸体 ABR 和 ARCR 评估相比，只有一名学员的术前基线表现达到了熟练标准，分别有 89%和 83%的注册学员达到了这一标准。
本研究的结果否定了零假设。它们表明，实施基于熟练程度的模拟课程来培训进行关节镜下 Bankart 和肩袖修复所需的技能，可以显著提高学员达到两项相关性能基准的能力。在为期两天半的课程中，有 89%和 83%的学员分别在 ABR 和 ARCR 中达到了熟练程度。
采用基于熟练程度的课程进行外科培训是高效、有效的，并有潜力提高患者安全性。
