Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.
Mayo Clinic, Rochester, Minnesota, USA.
Am J Sports Med. 2024 Sep;52(11):2702-2708. doi: 10.1177/03635465241270160. Epub 2024 Aug 29.
Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency.
To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows.
Case series; Level of evidence, 4.
A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine-accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions.
Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement ( < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement ( < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship ( = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship ( < .001).
This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.
传统上，对矫形外科受训者的评估是基于教师的主观评估。最近对基于价值的医疗保健的推动，对改善患者的预后提出了更高的要求。因此，矫形外科培训生的外科培训评估正在发展，以纳入更多评估能力的客观措施。
为矫形运动医学研究员开发一种新的手术技能评估方法，并随后证明其有效性。
病例系列；证据水平，4。
一个由 14 名接受过矫形运动医学培训的外科医生组成的团队使用改良 Delphi 法为前交叉韧带重建（ACLR）和肩袖修复（RCR）制定了客观的评分标准。根据 10 个手术步骤，根据核心能力制定了评分标准（1-5 分），最高总分为 50 分。邀请了来自区域多样化的运动医学认可的研究员计划的 14 名矫形研究员在研究员年度开始和结束时在外科技能实验室中完成 ACLR 和 RCR。一位运动医学外科医生对两次会议的每个手术步骤、整体表现和总手术时间进行了评估。
14 名研究员中有 13 名完成了研究员前后的评估。对于 ACLR 手术，研究员前的平均综合评分是 25.4（标准差，4.4），研究员后的平均综合评分是 38.6（标准差，4.1），这是一个具有统计学意义的提高（<.001）。对于 RCR 手术，研究员前的平均综合评分是 26.6（标准差，5.4），研究员后的平均综合评分是 38.8（标准差，4.3），这也是一个具有统计学意义的提高（<.001）。ACLR 手术的完成时间从研究员前的 82.3 分钟（标准差，4.3 分钟）提高到研究员后的 69.7 分钟（标准差，11.6 分钟）（<.001）。RCR 手术的完成时间从研究员前的 85.5 分钟（标准差，5.0 分钟）提高到研究员后的 76.4 分钟（标准差，7.0 分钟）（<.001）。
该手术技能计划代表了美国首次评估 2 项关节镜运动医学手术的标准化和可重复的工具。在 ACLR 和 RCR 方面，矫形运动医学研究员在研究员期间的综合表现有显著提高。所描述的方案有可能作为培训工具和正式的矫形运动医学研究员评估。
