Original Article
A Proficiency-Based Progression Simulation Training Curriculum to Acquire the Skills Needed in Performing Arthroscopic Bankart and Rotator Cuff Repairs—Implementation and Impact

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Purpose

To investigate the impact of a proficiency-based progression (PBP) curriculum employed to teach trainees in the skills needed to demonstrate proficiency for an arthroscopic Bankart repair (ABR) and an arthroscopic rotator cuff repair (ARCR) by objectively comparing pre- and immediate postcourse performances.

Methods

In a prospective study, 16 arthroscopy/sports medicine fellows and 2 senior residents (complete group: N = 18) were randomly assigned to perform a precourse cadaveric ABR (Bankart subgroup: N = 6), ARCR (cuff subgroup: N = 6), or basic skills on a shoulder simulator (N = 6). After completing a PBP training curriculum, all 18 registrants performed both an ABR and ARCR scored in real time by trained raters using previously validated metrics.

Results

The Bankart subgroup made 58% fewer objectively assessed errors at the completion of the course than at baseline (P = .004, confidence interval –1.449 to –0.281), and performance variability was substantially reduced (standard deviation = 5.89 vs 2.81). The cuff subgroup also made 58% fewer errors (P = .001, confidence interval –1.376 to 0.382) and showed a similar reduction in performance variability (standard deviation = 5.42 vs 2.1). Only one subject’s precourse baseline performance met the proficiency benchmark compared with 89% and 83% of the all registrants on the final ABR and ARCR cadaveric assessments, respectively.

Conclusions

The results of this study reject the null hypothesis. They demonstrate that the implementation of a PBP simulation curriculum to train the skills necessary to perform arthroscopic Bankart and rotator cuff repairs results in a large and statistically significant improvement in the trainee’s ability to meet the 2 related performance benchmarks. Proficiency was demonstrated by 89% and 83% of the trainees for an ABR and an ARCR, respectively, in a two- and one-half day course.

Clinical Relevance

Surgical training employing a PBP curriculum is efficient, effective, and has the potential to improve patient safety.

Section snippets

Participants/Subjects

Sixteen postgraduate Arthroscopy/Sports Medicine Fellows from 11 different programs in the United States and 3 international programs (Brazil, Canada, Mexico), along with 2 senior orthopaedic residents from a single US program participated in the PBP shoulder arthroscopy training curriculum (Fig 1). Enrollment was on a voluntary basis and tuition gratis. All subjects (n = 18) were assigned a unique identifying number that gave no indication of the fellowship or residency program in which they

Results

The mean and 95% confidence interval (CI) for the number of errors made by the Bankart Subgroup is shown in Fig 2. At the baseline assessment the Bankart subgroup made on average 6.33 errors. At final assessment, the errors for the Bankart subgroup were reduced by 58%. The complete group demonstrated a 79% decrease in errors compared with the baseline performance of the Bankart Subgroup. The difference was found to be statistically significant (coeff = –0.865, SE = 0.298, Z = 2.90, P >|Z| =

Discussion

In a repeated-measures assessment of the surgical skill for 2 arthroscopic shoulder procedures, dramatic improvement in performance was observed between baseline and completion of a proficiency-based progression training curriculum. Reduction in errors was the most significant difference at 58% for both an ABR and ARCR. When the baseline performances of the Bankart and rotator cuff subgroups were compared with the complete group’s final performance, the reduction in errors was even greater (79%

Conclusions

The results of this study reject the null hypothesis. They demonstrate that the implementation of a PBP simulation curriculum to train the skills necessary to perform arthroscopic Bankart and rotator cuff repairs results in a large and statistically significant improvement in the trainee’s ability to meet the 2 related performance benchmarks. Proficiency was demonstrated by 89% and 83% of the trainees for an ABR and an ARCR respectively, in a 2- and 1-half day course.

Acknowledgements

Shoulder PBP Instructional Faculty: Alan Barber, M.D., William Beach, M.D., Joseph Burns, M.D., Paul Caldwell, M.D., Alan Curtis, M.D., Julie Dodds, M.D., Larry Field, M.D., Marty Leland, M.D., Mark Getelman, M.D., Robert Hunter, M.D., John Kelly, M.D., Ben Kibler, M.D., Louis McIntyre, M.D., Gregg Nicandri, M.D., Keith Nord, M.D., Robert Pedowitz, M.D., Ph.D., John Richmond, M.D., Stephen Snyder, M.D., Jonathan Ticker, M.D., Ilya Voloshin, M.D., Brian Waterman, M.D., and Stephen Weber, M.D.

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  • Cited by (0)

    See commentary on page 1107

    This work was supported by Arthroscopy Association of North America Education Foundation.

    The authors report the following potential conflicts of interest or sources of funding: J.T. reports consultancy for CONMED, KFx Medical; and patent and stock options for FKx Medical. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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