2015 ISAKOS Biennial Congress ePoster #2106

Learning Curves in Shoulder Arthroscopy: Use of the Shoulder OPAT to Demonstrate Surgical Progression

Neil Jain, BM, MRCS(Ed), FRCS(Tr&Orth), Manchester UNITED KINGDOM
Chris Talbot, MRCS, Manchester UNITED KINGDOM
Martin Holt, FRCS(Orth), Manchester UNITED KINGDOM

University Hospital South Manchester, Manchester, UNITED KINGDOM

FDA Status Not Applicable

Summary: We have demonstrated the OPAT to be a useful assessment tool to demonstrate the learning curve for shoulder arthroscopy in that it enables monitoring of progression of arthroscopy skills and we thereby recommend its use.

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Abstract:

Introduction

An Objective Practical Assessment Tool (OPAT) has been developed to help trainee shoulder surgeons improve their surgical technique in carrying out a shoulder arthroscopy. This has been piloted in the UK and found to be popular with trainees and Trainers alike. We demonstrate the usefulness in using the OPAT to the trainee as a demonstration of progression along their learning curve for this procedure

Methods

The OPAT includes descriptors for 1) examination under anaesthesia, 2) surface anatomy, 3) arthroscope insertion, 4) visualisation and 5) probing of internal anatomy. Linked to each descriptor are points, which add to the score generated according to the skill level. The OPAT score rewards trainees proceeding in a logical fashion and respecting the tissues. The inclusion of a staged time record encourages trainees to continue even when they run into practical problems. Scores are converted to a percentage, and results are plotted for each case carried out. The first 20 shoulder arthroscopies performed by a Trainee were assessed using the OPAT. The findings were evaluated for percentage score, overall score, cumulative percentage (CUPER – a documented method for assessment of the surgical Learning Curve) and the global competency level. We also measured the time taken to both complete the assessment surgically and the time taken to record the score on the paperwork.

Results

Twenty arthroscopies were assessed and by using the OPAT we were able to demonstrate progression of surgical performance with shoulder arthroscopy. Geometric learning curves were clearly demonstrated for each of percentage score, overall score, cumulative percentage and the global competency level. The mean time to complete the OPAT surgical assessment intra-operatively was 4 minutes 43 seconds and the mean time to complete the paperwork was 2 minutes 17 seconds.

Discussion

By displaying the Learning Curve for shoulder arthroscopy we have demonstrated the benefits of the OPAT. Namely that it enables both trainees and trainers to monitor the progression of arthroscopic skills and helps the trainee, through objective measurements, in advancing their shoulder arthroscopy skills. We recommend its use.