Summary

When comparing 115 subjects (medical students, junior residents, senior residents, and attending orthopaedic surgeons) on six Fundamentals of Arthroscopic Surgery Training modules, there are measurable differences in time to completion, errors, and successfully tied knots that correlate with the subject's level of training.

Abstract

Introduction

The Fundamentals of Arthroscopic Surgery Training (FAST) Program offers an arthroscopic skills workstation and curriculum. The program was designed for surgeons in training to acquire and improve arthroscopic surgical skills. More expert surgeons would be expected to take less time to complete procedures while committing fewer errors. The purpose of this study was to compare medical students, orthopaedic trainees, and attending orthopaedic surgeons to demonstrate that time to completion, number of errors, and successfully tied knots is associated with level of training in arthroscopic surgery.

Methods

Seventy-eight orthopaedic surgery residents and seventeen medical students were enrolled at three orthopaedic surgery training sites. Twenty attending arthroscopic surgeons consisted of instructors at two Arthroscopy Association of North America Resident Arthroscopy Courses. Each participant completed six modules in random order. For each module, except knot tying which involved tying five knots, the participant completed the task twice, once with each hand in random order. For biting, maze navigation, probing, ring transfer, and suture passage, time to completion and errors were recorded. Number of successful knots was recorded for knot tying. Four groups were compared: medical students, junior residents (post-graduate year 1 through 3), senior residents (post-graduate year 4 and 5) and attending surgeons. Data for each trial was averaged and significance was set at p<0.05.

Results

Mean time to completion for biting was significantly slower for medical students compared to other groups (158 vs 101-122 seconds) and attending surgeons made significantly fewer errors than the junior resident and medical student groups (0.1 vs 1.4-2.0 errors, respectively). For the maze and probing completion time, senior and junior residents performed similarly (129-156 s and 156-165 s, respectively) while medical students were significantly slower (207 s and 214 s) and attendings were significantly faster (72 s and 96 s). Error rates completing both modules were similar. For ring transfer, all groups were significantly different and attendings were fastest, followed by seniors, juniors, and students (140, 221, 297, 428 s). Attendings made significantly fewer errors, and other groups performed similarly (0.9 vs 1.9-2.6 errors). For suture passage, attendings were significantly faster than all groups (203 s), and senior residents (410 s) were significantly faster than juniors and students (711, 772 s), which performed similarly. With regard to passage errors, attendings committed significantly fewer and other groups performed similarly (0.2 vs 1.5-1.7 errors). For number of successfully tied knots, there was no difference between attendings and seniors (3.8 and 2.9 knots), attendings were better than juniors (2.6 knots), and the medical student group was significantly worse than all others (1.4 knots).

Conclusion

When comparing medical students, junior residents, senior residents, and attending orthopaedic surgeons on six FAST modules, there are measurable differences in time to completion, errors, and successfully tied knots. In all circumstances, when significantly better performance was observed, it occurred in the more senior group. The FAST program can serve as a valuable tool in detecting objective changes as orthopaedic surgeons progress in their training and may help develop clinically applicable arthroscopic skills.