Validation of a Global Assessment of Arthroscopic Skills in a Cadaveric Knee Model

ArticleinArthroscopy The Journal of Arthroscopic and Related Surgery 29(1) · November 2012with9 Reads
DOI: 10.1016/j.arthro.2012.07.010 · Source: PubMed
Abstract
PURPOSE: The purpose of this study was to determine whether a global assessment of arthroscopic skills was valid for blinded assessment of cadaveric diagnostic knee arthroscopy. METHODS: A global skills assessment for arthroscopy was created using a published theory of the development of expertise. Faculty surgeons, fellows, and residents were consented and enrolled in this institutional review board-approved validation study. All participants were oriented to the equipment and procedures for diagnostic arthroscopy of the knee. After reviewing the anatomic structures to be visualized, participants were allowed 10 minutes to complete a diagnostic arthroscopy of the knee. The hands and arthroscopic view were recorded during this attempt. Resident participants completed a second filmed diagnostic arthroscopy 1 week after the initial attempt. Five blinded reviewers watched the synchronized videos and assessed arthroscopic skills with a procedure-specific checklist and the newly developed global skills assessment. The agreement between reviewers was determined by intraclass correlation coefficient. Internal consistency was determined with Cronbach's α. Test-retest reliability was measured by correlating repeated arthroscopies by residents. The ability of the global assessment to discriminate skill levels was determined with between-group Mann-Whitney U tests. RESULTS: The agreement between global assessment scores was strong (I.C.C. = 0.80, 95% C.I. 0.68-0.92). The internal consistency of evaluations was excellent (Cronbach's α = 0.97), and the test-retest reliability was strong (r = 0.52). The global assessment score was shown to be able to discriminate between skill levels by an analysis of variance indicating the difference in means among the various levels of training (P < .0001). CONCLUSIONS: The Objective Assessment of Arthroscopic Skills is a useful adjunct to arthroscopic educators and learners and could be used for in-training evaluations. CLINICAL RELEVANCE: The Objective Assessment of Arthroscopic Skills is an instrument that can be employed to measure the impact of skills curricula, including but not limited to simulation.
    • "curriculum to establish the proficiency of trainees [2, 3,[25][26][27][28][29][30][31]. Collaborative efforts of American orthopaedic and arthroscopy associations have proposed one such module for arthroscopic skills training; the ''FAST program'' [29]. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Arthroscopic skills training outside the operative room may decrease risks and errors by trainee surgeons. There is a need of simple objective method for evaluating proficiency and skill of arthroscopy trainees using simple bench model of arthroscopic simulator. The aim of this study is to correlate motor task performance to level of prior arthroscopic experience and establish benchmarks for training modules. Methods: Twenty orthopaedic surgeons performed a set of tasks to assess a) arthroscopic triangulation, b) navigation, c) object handling and d) meniscus trimming using SAWBONES “FAST” arthroscopy skills workstation. Time to completion and the errors were computed. The subjects were divided into four levels; “Novice”, “Beginner”, “Intermediate” and “Advanced” based on previous arthroscopy experience, for analyses of performance. Results: The task performance under transparent dome was not related to experience of the surgeon unlike opaque dome, highlighting the importance of hand-eye co-ordination required in arthroscopy. Median time to completion for each task improved as the level of experience increased and this was found to be statistically significant (p < .05) e.g. time for maze navigation (Novice – 166 s, Beginner – 135.5 s, Intermediate – 100 s, Advance – 97.5 s) and the similar results for all tasks. Majority (>85%) of subjects across all the levels reported improvement in performance with sequential tasks. Conclusion: Use of the arthroscope requires visuo-spatial coordination which is a skill that develops with practice. This simple box model can reliably differentiate the arthroscopic skills based on experience and can be used to monitor progression of skills of trainees in institutions.
    Full-text · Article · Nov 2016
    • "Several such scales exist for the assessment of arthroscopic technique. For the knee, these include the Arthroscopic Skills Assessment Form [39] , Modified Orthopaedic Competence Assessment Project [21] , The Basic Arthroscopic Knee Scoring System [40], Objective Assessment of Arthroscopic Skills global assessment form [41] and The Arthroscopic Surgical Skill Evaluation Tool [42]. As for the shoulder, there is the Modified Global Operative Assessment of Laparoscopic Skills [30]. "
    [Show abstract] [Hide abstract] ABSTRACT: Traditional orthopaedic training has followed an apprenticeship model whereby trainees enhance their skills by operating under guidance. However the introduction of limitations on training hours and shorter training programmes mean that alternative training strategies are required. To perform a literature review on simulation training in arthroscopy and devise a framework that structures different simulation techniques that could be used in arthroscopic training. A systematic search of Medline, Embase, Google Scholar and the Cochrane Databases were performed. Search terms included "virtual reality OR simulator OR simulation" and "arthroscopy OR arthroscopic". 14 studies evaluating simulators in knee, shoulder and hip arthroplasty were included. The majority of the studies demonstrated construct and transference validity but only one showed concurrent validity. More studies are required to assess its potential as a training and assessment tool, skills transference between simulators and to determine the extent of skills decay from prolonged delays in training. We also devised a "ladder of arthroscopic simulation" that provides a competency-based framework to implement different simulation strategies. The incorporation of simulation into an orthopaedic curriculum will depend on a coordinated approach between many bodies. But the successful integration of simulators in other areas of surgery supports a possible role for simulation in advancing orthopaedic education.
    Full-text · Article · Apr 2014
    • "Several such scales exist for the assessment of arthroscopic technique. For the knee, these include the Arthroscopic Skills Assessment Form [39] , Modified Orthopaedic Competence Assessment Project [21] , The Basic Arthroscopic Knee Scoring System [40], Objective Assessment of Arthroscopic Skills global assessment form [41] and The Arthroscopic Surgical Skill Evaluation Tool [42]. As for the shoulder, there is the Modified Global Operative Assessment of Laparoscopic Skills [30]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction Traditional orthopaedic training has followed an apprenticeship model whereby trainees enhance their skills by operating under guidance. However the introduction of limitations on training hours and shorter training programmes mean that alternative training strategies are required. Aims To perform a literature review on simulation training in arthroscopy and devise a framework that structures different simulation techniques that could be used in arthroscopic training. Methods A systematic search of Medline, Embase, Google Scholar and the Cochrane Databases were performed. Search terms included “virtual reality OR simulator OR simulation” and “arthroscopy OR arthroscopic”. Results 14 studies evaluating simulators in knee, shoulder and hip arthroplasty were included. The majority of the studies demonstrated construct and transference validity but only one showed concurrent validity. More studies are required to assess its potential as a training and assessment tool, skills transference between simulators and to determine the extent of skills decay from prolonged delays in training. We also devised a “ladder of arthroscopic simulation” that provides a competency-based framework to implement different simulation strategies. Conclusion The incorporation of simulation into an orthopaedic curriculum will depend on a coordinated approach between many bodies. But the successful integration of simulators in other areas of surgery supports a possible role for simulation in advancing orthopaedic education.
    Full-text · Article · Jan 2014 · International Journal of Surgery (London, England)
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