A Prospective Assessment of Knee Arthroscopy Skills Between Medical Students and Residents-Simulator Exercises for Partial Meniscectomy and Analysis of Learning Curves

Movement-based cognitive training does not significantly shorten the learning curve for acquiring arthroscopic basic skills

PURPOSE

Skilful arthroscopy requires an aboveaverage level of manual dexterity. It is evident that particular motor skills can be learned and trained before arthroscopic training. The aim of this prospective cohort study was to investigate the impact of movement-related cognitive training on the learning curve during arthroscopic basic training.

METHODS

Fifty right-handed participants without arthroscopic experience were matched to an intervention group (n = 25) and a control group (n = 25). Prior to basic arthroscopic skill training with a simulator, the intervention group underwent 12 weeks of movement-related cognitive training. Cognitive and motor skills were assessed in both groups by using standardised tests (CogniFit test, angle reproduction test, two-arm coordination test) as a pretest and, for the intervention group, again before arthroscopic training as a posttest. For arthroscopic simulator training, three tasks ('Telescoping', 'Periscoping', 'Triangulation') from the Fundamentals of Arthroscopic Surgery Training module were selected and practiced 10 times with the camera in the right and left hands. The learning progress was quantified by exercise time, camera path length and hook path length.

RESULTS

No significant differences in sex distribution, age distribution or the results of the pretests between the intervention group (n = 21) and the control group (n = 25) were found (n.s.). The intervention group improved significantly from the pretest to the posttest in the CogniFit (p = 0.003) and two-arm coordination test in terms of time (p < 0.001) and errors (p = 0.002) but not in the angle reproduction test. No significant differences were found between the groups for the three arthroscopic tasks.

CONCLUSION

The hypothesis that movement-related cognitive training shortens the learning curve for acquiring arthroscopic basic skills cannot be confirmed. Other factors influencing the learning curve such as talent, teaching method and motivation have a greater impact on the acquisition of complex motor skills.

LEVEL OF EVIDENCE

Level II.

The impact of surgery resident training on the duration of tibial plateau leveling osteotomy surgery

OBJECTIVE

To investigate the impact of surgery resident training on surgery duration in tibial plateau leveling osteotomy (TPLO) and evaluate whether surgery duration differs with each year of residency training.

STUDY DESIGN

Retrospective medical record review.

ANIMALS

A total of 256 client-owned dogs underwent TPLO.

METHODS

Records of dogs that underwent TPLO between August 2019 and August 2022 were reviewed. The effects of the surgeon (faculty/resident) and the procedure (arthrotomy/arthroscopy) on TPLO surgery duration were examined with an analysis of variance, and geometric least squares means (GLSM) were compared. A linear mixed effects model (LMM) was fitted to quantify fixed and random effects.

RESULTS

Four faculty surgeons performed 74 (29%) TPLOs, while 10 residents performed 182 (71%) TPLOs under the direct supervision of a faculty surgeon. All TPLOs were conducted with arthrotomy (109; 43%) or arthroscopy (147; 57%). Overall, residents (GLSM, 153 min) required 54% more surgery duration than faculty surgeons (GLSM, 99 min). Surgery duration among first-year residents (GLSM, 170 min) was 15% longer than second- (GLSM, 148 min) and third-year (GLSM, 147 min) residents, whereas the duration did not differ statistically between second- and third-year residents. Arthroscopy, meniscal tear treatment, surgery on the right stifle, and increasing patient weight were also associated with longer surgery duration.

CONCLUSION

The duration of TPLO surgery significantly decreased after the first year of residency, but did not decrease afterward.

CLINICAL SIGNIFICANCE

The results will aid with resource allocation, curricula planning, and cost management associated with resident training.

A spaced retraining schedule with 2-day interval improves the acquisition and retention of simulation-based basic arthroscopic skills

PURPOSE

To compare the effect of three differently spaced retraining schedules (1-day, 2-day, and 1-week intervals) on the acquisition of basic arthroscopic skills and skill retention after 3 months.

METHODS

Thirty orthopaedic residents without arthroscopic experience were enrolled in a double-blind, randomised, parallel-controlled trial. Spaced retaining schedules were divided into massed training and retraining phases. Participants were required to obtain perfect scores in all tasks on the simulator in the massed training phase, followed by a pretest to evaluate the training effect. During the retraining phase, participants were randomly assigned to Groups A (1-day interval), B (2-day interval) or C (1-week interval). A posttest was used to evaluate the effect of different retraining patterns. Follow-up evaluations were conducted at 1 week, 1 month and 3 months after the completion of spaced retraining schedules to measure skill retention. One-way ANOVA and paired-sample t tests were used for statistical analysis.

RESULTS

Significant between-group differences in diagnostic arthroscopy (137.0 ± 24.8 vs. 140.1 ± 21.3 vs. 175.3 ± 27.4 s, P(A-C) = 0.005, P(B-C) = 0.010) and loose body removal (193.1 ± 33.9 vs. 182.0 ± 32.1 vs. 228.7 ± 42.9 s, P(B-C) = 0.025) completion times were observed. No significant differences were found in other posttest metrics. An assessment of skill retention after the 3-month follow-up (Evaluation 3) showed significant differences in diagnostic arthroscopy completion time (202.5 ± 53.3 vs. 172.0 ± 27.2 vs. 225.5 ± 42.1 s, P(B-C) = 0.026). No significant differences were found in other Evaluation 3 metrics.

CONCLUSION

The 2-day retraining schedule was the most effective for the acquisition and retention of basic arthroscopic skills and could be integrated into arthroscopic skills curricula. After a 3-month follow-up, residents who followed this schedule showed better skill retention than those who followed the 1-week interval schedule.

LEVEL OF EVIDENCE

Level I.

Orthopaedic Surgery Training and Education During COVID-19: A Systematic Review

COVID-19 forced surgical resident training programs to adapt to meet educational requirements within the constraints of various guidelines. Some of the changes implemented during the pandemic have imparted a lasting effect on orthopaedic education. As such, the purpose of this article was to review how orthopaedic training and education were affected during the COVID-19 pandemic.

Methods

The published literature was queried using search strategies devised by a medical librarian, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Studies eligible for inclusion were studies related to COVID-19, orthopaedic surgical training, and medical education. Studies were excluded if they (1) were abstracts, conference proceedings, letters, perspective pieces, reviews, or editorials; (2) evaluated medical student education; (3) included other specialties; or (4) were unrelated to COVID-19 and/or orthopaedic training.

Results

Eighty-three (n = 83) studies were included. Five themes emerged including (I) Fellowship Application, Interview, and Match Processes; (II) Social Media and Websites for Program Information; (III) Changes in Trainee Surgical Volume; (IV) Trainee Mental Health and Well-being; and (V) Innovations in Education. The pandemic decreased opportunities for medical students to gain exposure to orthopaedic surgery. Social media use, particularly Instagram, among orthopaedic residencies increased during the pandemic. Between the cancellation of away rotations and in-person interviews, applicants saved over $6,000; however, both residency applicants and interviewers preferred in-person interviews. The pandemic led to decreased surgical volume and in-person didactics for trainees, thus relying more on virtual learning. Orthopaedic trainees had mixed feelings regarding online virtual education. Although some respondents reported that they preferred the convenience of online learning, others expressed dissatisfaction with the quality of virtual education.

Conclusions

The shift to virtual learning affected how applicants learned about residency programs, with many relying on virtual away rotations and social media to compare different programs. The pandemic also highlighted issues of diversity and accessibility within orthopaedic surgery, with cost savings from virtual interviews and canceled away rotations potentially benefiting applicants from lower socioeconomic backgrounds. Although some innovative approaches and adaptations to orthopaedic education and training have shown promise and may continue to be used in the future after the COVID-19 pandemic, the role of others, such as virtual interviews, is less clear.

Learning and Short-Term Retention of Simulation-Based Arthroscopic Skills

OBJECTIVE

The study aimed to examine the learning curve and short-term retention of arthroscopic skills acquired on a simulator.

DESIGN

Cohort study.

SETTING

Clinical Skills Training Center of Zhujiang Hospital of Southern Medical University PARTICIPANT AND METHODS: Orthopaedic residents (n = 14) without previous arthroscopy experience were included. After basic information was collected and an initial arthroscopy knowledge level test was administered, the subjects received standardised training on the simulator (day 1); then, they completed tasks on the simulator, including guided diagnostics (4 times), triangulation (5 times) and loose body removal (7 times). A learning curve for each skill was generated based on the total scores. The score of the last repetition of each task was the training level.

RESULTS

A total of 14 orthopedic residents were enrolled. All participants completed the training and testing. There was a learning curve over the course of training for all 3 arthroscopic skills (p < 0.001). On day 8 after the training, the mean score for guided diagnostics decreased from 49.9 to 48.9 (p = 0.001), and the retention rate was 97.8%. For triangulation, the mean total score decreased from 58.9 to 53.6 (p < 0.001), and the retention rate was 90.8%. For loose body removal, the mean total score decreased from 87.1 to 80.7 (p < 0.001), and the retention rate was 92.7%.

CONCLUSIONS

Orthopaedic residents' arthroscopic skills learned through simulator training declined significantly in 1 week after the training, especially more difficult skills.