Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea.
Clin Orthop Surg. 2021 Dec;13(4):513-519. doi: 10.4055/cios20259. Epub 2021 Nov 15.
Ultrasound is commonly used for evaluating rotator cuff tears. However, little training in ultrasound imaging is provided during orthopedic residents' training period. Therefore, we performed this study to determine how many ultrasound scans are required for orthopedic residents to be competent and self-confident in the diagnosis of supraspinatus tendon tears and to investigate whether senior residents outperformed junior residents.
We studied two third-year residents who had no previous experience of shoulder ultrasound and evaluated their ability to detect rotator cuff pathologies. Their learning curves were plotted using a cumulative summation analysis with a 20% acceptable failure rate compared to arthroscopic findings. Downward, upward, and horizontal cumulative summation trends indicated incompetence, exceptional competence, and competence, respectively. The diagnostic accuracy of third-year residents was compared with that of second-year residents and the number of cases required to gain self-confidence was evaluated.
Cumulative summation analysis showed that after 26-28 scans, residents achieved the competence to correctly diagnose supraspinatus tears: an upward trend was observed from the beginning for full-thickness tears and a downward trend was observed for partial-thickness tears. Sensitivity and specificity were 0.95 and 0.79, respectively, for third-year residents and 0.91 and 0.58, respectively, for second-year residents. Residents reported self-confidence after 30 ultrasound scans for the detection of rotator cuff tears.
The number of scans that novices needed to be competent for detecting rotator cuff tears was approximately 30 cases, and the diagnostic accuracy of third-year residents was significantly higher than that of second-year residents.
超声检查常用于评估肩袖撕裂。然而，在骨科住院医师培训期间，很少提供超声成像方面的培训。因此，我们进行了这项研究，以确定骨科住院医师需要进行多少次超声扫描才能胜任并自信地诊断冈上肌腱撕裂，并探讨是否资深住院医师优于初级住院医师。
我们研究了两名没有肩部超声经验的三年级住院医师，并评估了他们检测肩袖病变的能力。他们的学习曲线使用累积和分析绘制，接受率为 20%，与关节镜检查结果相比。下降、上升和水平的累积和趋势分别表示不熟练、出色的能力和熟练。比较了三年级住院医师的诊断准确性和二年级住院医师的数量，并评估了获得自信所需的病例数。
累积和分析显示，在进行 26-28 次扫描后，住院医师能够正确诊断冈上肌腱撕裂：全层撕裂的趋势从一开始就呈上升趋势，而部分厚度撕裂的趋势则呈下降趋势。三年级住院医师的敏感性和特异性分别为 0.95 和 0.79，二年级住院医师的敏感性和特异性分别为 0.91 和 0.58。住院医师在进行 30 次超声检查以检测肩袖撕裂后报告了信心。
新手需要进行大约 30 次扫描才能熟练检测肩袖撕裂，三年级住院医师的诊断准确性明显高于二年级住院医师。
