Residents as Educators: A Modern Model

The Undermined ACGME Subcompetency: A Roadmap for Radiology Residency Programs to Foster Residents-as-Educators

Radiology Residency programs in the United States use a set of six core competencies as laid out by the Accreditation Council for Graduate Medical Education (ACGME) to evaluate the foundational skills of every resident. Despite the fact that educational skills are included under the heading of Practice-Based Learning and Improvement in the ACGME guidelines for radiology residents, it is often underappreciated and undervalued, when compared with medical knowledge or patient care. In this paper, the authors lay out the important role of residents-as-educators and how it can be inculcated as part of formal training during residency. They enunciate five pillars for academic programs to build and maintain the pedagogical skills of their radiology residents: Training, Practicing, Providing Feedback, Mentoring, and Changing the Culture. The authors believe that implementing this will holistically benefit radiology residents as well as radiology in building future educators. The authors also delineate the challenges that programs currently face in implementation and ways to overcome them.

Comparing Faculty and Trainee Evaluators of First-Year Resident Skills

OBJECTIVE

To determine if senior residents are comparable to faculty in assessing first-year resident skills on their overall assessment.

BACKGROUND

As resident training moves towards a competency-based model, innovative approaches to evaluation and feedback through simulation need to be developed for both procedural as well as interpersonal and communication skills. In most areas of simulation, the faculty assess resident performance however; in clinical practice, first-year residents are often overseen and taught by senior residents. We aim to explore the agreement between faculty and senior resident assessors to determine if senior residents can be incorporated into a competency-based curriculum as appropriate evaluators of first-year resident skills.

DESIGN

Annual surgical first year resident training for central line placement, obtaining informed consent and breaking bad news at a single institution is assessed through an overall assessment (OA). In previous years, only faculty have been the evaluators for the OA. In this study, select senior residents were asked to participate as evaluators and agreement between groups of evaluators was assessed across the 3 tasks taught during surgical first-year resident training.

SETTING

Vanderbilt University Medical Center, tertiary hospital, Simulation Center.

PARTICIPANTS

Anesthesia and surgery interns, chief residents, anesthesia and surgical faculty.

RESULTS

Agreement between faculty and senior resident assessors was strongest for the central line placement simulation with a faculty average competency score of 10.71 and 9.59 from senior residents (κ = 0.43; 95% CI: -0.2, 0.34). Agreement was less substantial for simulated informed consent (κ = 0.08; 95% CI: -0.19, 0.36) and the breaking bad news simulation (κ = 0.07; 95% CI: -0.2, 0.34).

CONCLUSION

Select senior residents are comparable to faculty evaluators for procedural competency; however, there was less agreement between evaluator groups for interpersonal and communication-based competencies.

Implementation and Assessment of Mentoring and Professionalism in Training (MAP-IT): A Humanistic Curriculum as a Tool to Address Burnout in Surgical Residents

OBJECTIVE

Mentoring and Professionalism in Training (MAP-IT), a humanistic mentorship program, has demonstrated positive impact in non-surgical fields. This study assesses the feasibility of implementing MAP-IT in surgical residency and adapts MAP-IT to include residents-as-teachers (RAT). We hypothesize that MAP-IT will benefit surgical residents by building humanistic teaching skills, increasing resilience, reducing burnout, and improving connectedness.

DESIGN

MAP-IT was implemented monthly during protected educational time. Faculty surgeons who had previously completed MAP-IT served as facilitators. Small groups consisted of 12 trainees, two faculty facilitators, and one resident facilitator. Each session comprised 60 minutes of reflection, readings, and discussion surrounding humanistic mentoring skills. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS), Connor Davidson Resilience Scale (CD-RISC), and Humanistic Teaching Practices Effectiveness Questionnaire (HTPE) were administered before and after participation in MAP-IT. Qualitative interviews and surveys assessed residents' perspectives of the MAP-IT program.

SETTING

MAP-IT was implemented at Northwell-North Shore/LIJ in Manhasset, NY in a general surgery residency program hosted by two tertiary care hospitals within a large health system.

PARTICIPANTS

55 residents participated as learners, five residents served as resident-facilitators, and 10 surgical faculty served as paired-facilitators of the MAP-IT course.

RESULTS

31.6% of residents had participated in a reflective medicine curriculum prior to MAP-IT, and these residents reported greater resilience and less burnout. This disparity was eliminated after participation in MAP-IT. Frequency of burnout was reduced from 64.1% to 46.1% after MAP-IT participation. Post-program, residents reported greater effectiveness in humanistic teaching practices when compared to baseline assessments. Quantitative and qualitative feedback demonstrated that MAP-IT was well received by resident participants and addressed a gap in their surgical training.

CONCLUSIONS

A humanistic mentorship program involving RAT can be effectively implemented in surgical residency, is well-received by residents, and addresses a need surgical training by building skills and improving resident well-being.

Facilitating an Optimal Transition to Residency in Obstetrics and Gynecology

The transition to residency in obstetrics and gynecology is difficult, threatening the well-being of residents as well as their preparedness to care for patients. In addition to essential foundational knowledge and skills, obstetrics and gynecology interns must develop professional identity and a growth mindset toward learning to acquire the self-directed learning skills required of physicians throughout their careers. The transition to residency is a critical opportunity for learning and development. A group of educators and learners from around the country created a preparedness program building on available resources. The result is a national curriculum for improving the transition to obstetrics and gynecology residency on three levels: self-directed learning, facilitated small-group workshops, and coaching. Sharing tools for preparing matched applicants for residency in obstetrics and gynecology ensures adequate residency preparation for all interns, independent of medical school attended. This program aims to address potential threats to equity in the training of our future workforce and to ensure that all obstetrics and gynecology interns are prepared to thrive in residency training.

Evaluating General Surgical Residency Education Structure and Incorporation of the Resident as Educator Model

BACKGROUND

General surgery education has continued to evolve regarding test preparation, simulation, and skill acquisition. The "Resident as Educator" (RAE) model has been proposed and enacted by programs as a viable education model for general surgery education. This study examines the current education structures in general surgery residency programs in the United States and how many programs have adopted the RAE model or aspects of the model.

METHODS

A 20-question survey regarding education structure was distributed to all program directors in October 2021. Questions focused on the involvement of residents in leading education sessions, creating the weekly education schedule, program feedback to residents on teaching, and recognition for distinguished resident educators.

RESULTS

A total of 156 programs responded to the survey. The response rate was 60%. 76.4% of the respondents have a combination of resident and faculty-led didactic sessions, 8.5% have an RAE model, and 15% have faculty-led education sessions. In terms of concerns regarding resident-led didactics-24.4% of respondents stated that their main concern would be the quality of education provided, and 20.4% referenced low resident satisfaction levels with resident-led education. There were no differences among the groups regarding the American Board of Surgery board passage rates.

CONCLUSIONS

Most residency programs have adopted a model in which residents have significant involvement in creating and maintaining the education calendar and leading formal education sessions. However, only 8.5% have a purely resident-led educational curriculum among the responding programs. More studies are needed to assess how to implement a resident as educator model successfully.

Radiation Exposure Among Orthopaedic Trauma Surgeons: Deconstructing Commonly Held Myths and Misperceptions

OBJECTIVES

To review and evaluate the validity of common perceptions and practices regarding radiation safety in orthopaedic trauma.

DESIGN

Retrospective study.

SETTING

Level 1 trauma center.

SUBJECTS

N/A.

INTERVENTION

The intervention involved personal protective equipment.

MAIN OUTCOME MEASUREMENTS

The main outcome measurements included radiation dose estimates.

RESULTS

Surgeon radiation exposure estimates performed at the level of the thyroid, chest, and pelvis demonstrate an estimated total annual exposure of 1521 mR, 2452 mR, and 1129 mR, respectively. In all cases, wearing lead provides a significant reduction (90% or better) in the amount of radiation exposure (in both radiation risk and levels of radiation reaching the body) received by the surgeon. Surgeons are inadequately protected from radiation exposure with noncircumferential lead. The commonly accepted notion that there is negligible exposure when standing greater than 6 feet from the radiation source is misleading, particularly when cumulative exposure is considered. Finally, we demonstrated that trauma surgeons specializing in pelvis and acetabular fracture care are at an increased risk of exposure to potentially dangerous levels of radiation, given the amount of radiation required for their caseload.

CONCLUSION

Common myths and misperceptions regarding radiation in orthopaedic trauma are unfounded. Proper use of circumferential personal protective equipment is critical in preventing excess radiation exposure.

"Residents as Teachers" Workshops Designed by Surgery Residents for Surgery Residents

BACKGROUND

A core tenet of medical education is the expectation that senior residents will teach junior residents and medical students. However, many general surgery residency programs lack a formalized curriculum to equip trainees with necessary teaching skills. We evaluated the impact of resident-led residents-as-teachers (RAT) workshops (RATW) and assessed adaptability from in-person to virtual delivery. We hypothesized these courses would improve trainees' confidence in their roles as resident-teachers.

METHODS

Pre-COVID-19, an in-person workshop for residents (PGY1-5) was conducted over two days. During the COVID-19 pandemic, a virtual RATW for incoming interns (PGY1) was conducted during intern boot camp. Topic fidelity was preserved between the two RATWs. Resident-educators were responsible for content and delivery; the program director and associate program directors served as facilitators only. Surveys were used to evaluate residents' confidence in four core topics. A Wilcoxon test was used to compare quantitative data.

RESULTS

There was significant improvement in confidence in all areas following RATW attendance, except for "Teaching in the OR". In sub-analysis, there was a significant improvement in this category among incoming interns post-RATW (P < 0.001). The majority of interns agreed that the RATW helped them transition into their new teaching role and agreed that the resident-led RATW was effective.

CONCLUSIONS

A resident-designed and resident-led RAT curriculum in general surgery effectively improves residents' confidence in teaching and is well received by residents. We recommend the implementation of a RAT curriculum in general surgery residency and intern boot camp. The RATW was well adapted to distance-learning format.

Teaching on Rounds and in Small Groups

Bedside teaching plays a vital role the training future physicians, allowing for instruction in history taking, physical examination skills, differential diagnosis development, professionalism, teamwork integration, effective communication, and discussions of medical ethics. Due to changes in the health care system, accreditation bodies, and shortened admittance of patients, rates of bedside teaching have declined. Attending surgeons feel increased external pressures to meet performance metrics while resident physicians adhere to duty hour restrictions. This article highlights popular methods, including bedside rounds, near-peer teaching, and resident versus attending preceptors, and discusses how teaching on rounds has an impact on patients.

A Qualitative Analysis of Surgical Faculty and Surgical Resident Perceptions of Potential Barriers to Implementing a Novel Surgical Education Curriculum

OBJECTIVE

Sociocultural differences between patients and physicians affect communication, and suboptimal communication can lead to patient dissatisfaction and poor health outcomes. To mitigate disparities in surgical outcomes, the Provider Awareness and Cultural dexterity Toolkit for Surgeons was developed as a novel curriculum for surgical residents focusing on patient-centeredness and enhanced patient-clinician communication through a cultural dexterity framework. This study's objective was to examine surgical faculty and surgical resident perspectives on potential facilitators and barriers to implementing the cultural dexterity curriculum.

DESIGN, SETTING, AND PARTICIPANTS

Focus groups were conducted at 2 separate academic conferences, with the curriculum provided to participants for advanced review. The first 4 focus groups consisted entirely of surgical faculty (n = 37), each with 9 to 10 participants. The next 4 focus groups consisted of surgical residents (n = 31), each with 6 to 11 participants. Focus groups were recorded and transcribed, and the data were thematically analyzed using a constant, comparative method.

RESULTS

Three major themes emerged: (1) Departmental and hospital endorsement of the curriculum are necessary to ensure successful rollout. (2) Residents must be engaged in the curriculum in order to obtain full participation and "buy-in." (3) The application of cultural dexterity concepts in practice are influenced by systemic and institutional factors.

CONCLUSIONS

Institutional support, resident engagement, and applicability to practice are crucial considerations for the implementation of a cultural dexterity curriculum for surgical residents. These 3 tenets, as identified by surgical faculty and residents, are critical for ensuring an impactful and clinically relevant education program.

Effectiveness of surgical residents compared to surgical faculty in teaching trauma evaluation and management

Introduction

Senior medical students learn trauma principles in a 90-min interactive teaching session based on the trauma evaluation and management module designed by the American College of Surgeons. However, the number of surgical faculty available to conduct these interactive small group sessions is limited. The goal of this study is to compare the effectiveness of surgical residents to that of surgical faculty in teaching trauma principles.

Methods

53 senior medical students received trauma teaching from trauma faculty ( n = 22), trauma residents ( n = 21), or no teaching ( n = 10). Students were tested on cognitive trauma knowledge (20 multiple choice questions) and clinical trauma simulation (using objective structured clinical performance score). All students completed a 5-point subjective questionnaire.

Results

Students receiving trauma teaching outperformed students receiving no teaching in the knowledge test (mean 13.0 ± 3.6 standard deviation (SD) vs. 8.4 ± 2.4 SD, p < 0.05), while faculty and resident teaching outcomes were similar (mean 12.6 ± 3.0 SD vs. 13.4 ± 4.1, p = 0.45). Similarly, in the clinical trauma simulation, students receiving trauma teaching scored better (objective score mean 78% vs. 56%, p < 0.05), while there was no difference between faculty and resident teaching outcomes (objective score mean 77% vs. 80%, p = 0.52). In the subjective questionnaire, students who received trauma teaching rated themselves higher on a scale of 10 in trauma knowledge and skills than those who did not have formal teaching (mean 5.2 vs. 2.1, p < 0.05) as resident and attending teaching group ratings were similar.

Conclusions

Although small group discussions and increased simulation enhance undergraduate surgical trauma education, the number of faculty surgeons needed to fully incorporate these activities is limited. Objective and perceived effectiveness of teaching trauma management by surgical residents compared to trauma attendings is equivalent. This highlights the opportunity to incorporate residents into teaching roles to bridge the gap in undergraduate trauma education.

Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors

Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.

In Pursuit of the Most Effective Method of Teaching Feedback Skills to Emergency Medicine Residents in Qatar: A Mixed Design

Purpose

The study aimed to find an effective method of teaching feedback skills to residents and to gauge their preference.

Method

This was a mixed design study conducted at the emergency department of a large tertiary care hospital. The residents were randomized to groups A, B, and C. Group A (control) received a traditional lecture, Group B read a specifically written brief document, and Group C received 1:1 tutoring from one faculty. Each resident individually watched a four-minute video on an emergency procedure and provided feedback in simulated settings, which was audio-recorded and rated by two blinded raters. An assessment form was created and validated. The residents’ preference was attained through a semi-structured interview.

Results

The baseline characteristics of the three groups were similar. Compared to Group A, Groups B and C scored significantly higher on the overall assessment and were statistically similar to each other. There was no sign of association between both gender and postgraduate score (PGY) year on the total score. Residents’ equally preferred self-reading and 1:1 tutoring.

Conclusion

The acquisition of feedback skills by emergency medicine (EM) residents was comparable between self-learning from an appropriately written document and 1:1 teaching by adequately trained faculty.

Developing Residents as Medical Educators via the McMaster Multidisciplinary Academic Day Planning Committee

Background

Residents are being asked to perform educator roles such as curriculum design and learner assessment with minimal professional development in leadership or medical education. The Multidisciplinary Academic Day (MAD) planning committee is a resident-led initiative responsible for delivering combined educational half-day sessions and workshops for all residents at McMaster University.

Objective

We sought to determine the impact participation in MAD planning committee had on residents' professional development and career goals. 

Methods

We conducted a program evaluation survey of 19 of 30 (63.3%) current and former committee members to determine how the MAD planning committee’s alumni perceived its usefulness, and how participation affected their professional development. 

Results

Residents cited a desire to gain medical education experience, learn about event planning and management, and improve resident education as reasons for joining the committee; 89.5% of respondents felt they had met these goals. Experience on the committee included skills related to curriculum design, developing needs assessments and programmatic evaluation. Many residents felt it helped them acquire leadership skills such as decision-making, idea generation, delegation, and public speaking. Several noted that it had sparked an interest in medical education as part of an academic career, and one former member subsequently pursued a Master’s of Education. The majority of the respondents (78.9%) felt it was helpful for their careers and 94.7% would recommend this experience to others interested in leadership and medical education. 

Conclusion

Involvement in the MAD planning committee is a highly useful way for residents to acquire leadership skills, develop an interest in medical education and work in a multidisciplinary team. 

Interns as medical educators: student and intern experiences from the intern-delivered teaching program at University Hospital Limerick

BACKGROUND

The acquisition and assimilation of knowledge through history-taking and clinical skills practice are core aspects of training for medical students. Interns, who have recently graduated and have entered into clinical practice, are uniquely positioned to assume a pivotal role in student education.

AIMS

The goal of this study was to evaluate feedback from both students as well as intern tutors on the intern-delivered teaching program at University Hospital Limerick (UHL) from 2015 to 2016.

METHODS

Eighty-five interns participated in the program at UHL in 2015 and 2016, aiming to deliver four 1-h tutorials to 285 Year 3 or Year 4 students from UL Graduate Entry Medical (GEMS) Program. A flexible schedule focused on practical skills and knowledge translation was created with oversight from Lead Interns and Professor of Medicine, with administrative support. Feedback was assessed using anonymous survey questionnaires.

RESULTS

The survey response rate was 74% in 2015 and 75% in 2016. Student feedback on the performance of intern tutors was positive. More than 50% of students deemed tutorials on history-taking and clinical examination as the most valuable. Over 76% of students indicated a desire to participate as tutors after graduation. Logistical issues in agreeing mutually suitable timeslots were identified as the major barrier for delivery of teaching. From the intern perspective, over 85% reported benefits in areas of professional development and knowledge consolidation.

CONCLUSIONS

Participation in intern-delivered teaching leads to clinical and educational benefits for both students and interns. However, several logistical barriers were identified and require refinement.

Students Teaching Students: A Novel Solution for Teaching Procedures via Instruction on the Corpse

INTRODUCTION

Increased faculty and resident responsibilities have led to the decreased time available for teaching clinical skills to medical students. Numerous advances in education and simulation have attempted to obviate this problem; however, documented success is lacking. Our objective was to describe a novel fresh cadaver-based, student-driven procedural skills lab and to compare the educational effectiveness of student instructors to the senior instructor (SI).

METHODS

This was a prospective study performed at an academic medical center. A pilot program, "Students Teaching Students," was introduced where four trained first-year medical students (TMS) instructed 41 other untrained first-year medical students in technical procedures. This study compared the teaching evaluations of the SI with the TMS teaching equivalent procedures. Paired t-test was used to determine statistically significant changes in procedural confidence between pre- and post-training. Utilizing a post-training questionnaire, average post-training confidence improvement values and objective post-training test scores of the participants were compared between TMS and SI, using a 2 sample t-test. Statistical significance was considered as a P-value<0.05. All statistical analyses were conducted in Stata 11 (StataCorp LP, College Station, TX, USA).

RESULTS

Twenty-nine out of 39 (74%) students completed the questionnaire. Both groups demonstrated a statistically significant improvement in subjective confidence level in performing each procedure when pre- and post-training scores were compared, while there was no statistically significant difference found in cognitive knowledge between the groups (p=0.73). There was no statistically significant difference in the mean confidence improvement between the SI and TMS groups for chest tube insertion (2.06 versus 1.92 respectively, p=0.587), femoral line placement (2.00 versus 1.94 respectively, p=.734) or student test score (88% versus 85% respectively).

CONCLUSION

Our results demonstrate that first-year medical students well-trained in technical skills, such as our TMS, may be a valuable additional teaching resource. The Students Teaching Students procedure lab employed in this study was effective at immediately increasing first-year medical students' confidence and technical skill. First-year medical students well-trained in technical skills, such as our TMS, may be a valuable additional teaching resource.

The efficacy of peer teaching for medical microbiology lectures

This article was migrated. The article was marked as recommended. Background: A thorough understanding of infectious diseases is needed by medical professionals; therefore effective microbiological teaching is critical. Although faculty lectures are a convenient means of educating large groups of students, they may fail to engage students and convey an understanding of the subject. Therefore, we developed peer teaching methods based on game-based learning using a reality musical talent show format. Methods: A group of student representatives were trained to lecture to a class of 300 third-year medical students via a game show format over a 3-year period (2013-2015). Results: The students reported a higher level of understanding (3.6-4.2 vs 3.6-3.9 out of 5; p Conclusions: Peer teaching did improve the students' attitude towards learning and conferred teaching skills, but the learning activity needs adjustment to reduce the out-of-class preparation time.

Cultivating Future Radiology Educators: Development and Implementation of a Clinician-Educator Track for Residents

Effective and dedicated educators are critical to the preservation and advancement of the practice of radiology. The need for innovative and adaptable educators is increasingly being recognized, with several institutions granting academic promotions through clinician-educator tracks. The implementation of resident "clinician-educator tracks" or "teaching tracks" should better prepare residents aspiring to become academic radiologists focused on teaching. In this work, we describe our experience in the development and implementation of a clinician-educator track for diagnostic radiology residents at our institution.

Effect of an Emergency Medicine Resident as Team Leader on Outcomes of Trauma Team Activations

OBJECTIVES

Traditionally, a surgeon has served as trauma team leader (TTL). However, this role is increasingly being performed by emergency medicine (EM) physicians. At the Halifax Infirmary, we utilize a resident TTL (rTTL) under supervision of a staff traumatologist, a duty shared between EM and surgical residents. Our objective was to compare outcomes between cases led by EM and surgical rTTLs.

METHODS

This was a retrospective case-control study of data collected from the Nova Scotia Trauma Registry. Eligible cases were attended to by the trauma team from April 4, 2014, to March 31, 2015. Primary outcome of interest was in-hospital mortality. Secondary outcomes included hospital admission, hospital length of stay (LOS), intensive care unit (ICU) admission, ICU LOS, ventilator requirement, operating room use, and time to operating room. Univariate comparisons were made using t-tests and Fisher's test. We used logistic and linear regression to adjust for confounding.

RESULTS

A total of 571 patients were included in the analysis. A total of 179 (31.3%) were managed by an EM resident and the remainder were managed by a surgical resident. There was no statistical difference in mortality or secondary outcomes on the crude or adjusted estimates. Eighteen patients (10.1%) in the EM group died compared to 37 (9.4%) in the surgical group.

CONCLUSIONS

There was no difference in any patient outcome between cases managed by EM and surgical rTTLs. These findings support the philosophy that both groups are effective as rTTLs and should be trained in trauma leadership. Further research is warranted in introducing the rTTL into other systems.

Curated Collections for Educators: Five Key Papers about Residents as Teachers Curriculum Development

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to prepare residents to teach and assess medical students and other learners. In order to achieve this, many programs develop formal residents as teachers (RAT) curricula. Medical educators may seek the guidance of previously published literature during the development of RAT programs at their institutions. The authors sought to identify key articles published on the subject of RAT programs over the last 10 years. The authors utilized a formal literature search with the help of a medical librarian and identified additional articles from virtual discussions among the author group and an open call for articles on Twitter using the hashtag #MedEd. Virtual discussions occurred within an online community of practice, the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. The lead author conducted a four-round modified Delphi process among the author group in order to narrow the broad article list to five key articles on RAT programs. The authors summarize each article and provide considerations for junior faculty as well as faculty developers. Curriculum development and program evaluation should utilize established frameworks and evidence-based approaches. The papers identified by this Delphi process will help faculty use best practices when creating or revising new RAT curriculum. In addition, faculty tasked with guiding junior faculty in this process or creating faculty development programs around curriculum development will find these articles to be a great resource for building content.

Effectiveness of a Low-Cost Drilling Module in Orthopaedic Surgical Simulation

INTRODUCTION

Financial pressures and resident work hour regulations have led to adjunct means of resident education such as surgical simulation. The purpose of this study is to determine the effectiveness of a hands-on training session in orthopaedic drilling technique educational model during a surgical simulation on reducing drill plunging depth and to determine the effectiveness of senior residents teaching a hands-on training session in orthopaedic drilling technique.

METHODS

A total of 13 participants (5 orthopaedic interns and 8 medical students) drilled until they penetrated the far cortex of a synthetic bone model and the plunging depth (PD) was measured. They were then randomized and underwent an education session with an attending orthopaedic surgeon or a senior resident. Next, the subjects drilled again with the PD being calculated. The preeducational and posteducational session were compared to determine if there was any improvement in PD and if there was a difference between educators. The cost of the model was also determined.

RESULTS

The mean maximum PD and mean PD before the education session was 1.58 (1.40-2.10) and 1.50cm (1.36-1.76), respectively. Following the educational session, the mean maximum PD and mean PD were 0.53 (0.42-0.75) and 0.50cm (0.40-0.72), respectively. These were both significantly lower than before the education session (p <0.05). After the educational session taught by the attending versus the session taught by the resident, the mean maximum PD was 0.59 (0.42-0.75) and 0.49cm. (0.45-0.75), respectively (p = 0.44). After the educational session taught by the attending versus the session taught by the resident, the mean PD was 0.54 (0.40-0.72) and 0.47cm. (0.40-0.65), respectively (p = 0.44). The cost of the station per participant was $5.44.

CONCLUSION

This study demonstrated a significant reduction in drilling PD with use of a low-cost training model and a formal didactic and skills session on proper drilling technique that can effectively be led by senior residents.