Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleA Proficiency-Based Progression Simulation Training Curriculum to Acquire the Skills Needed in Performing Arthroscopic Bankart and Rotator Cuff Repairs—Implementation and Impact
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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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.