Can Surgical Trainees Achieve Arthroscopic Competence at the End of Training Programs? A Cross-sectional Study Highlighting the Impact of Working Time Directives

Abstract

The numbers to achieve competent arthroscopic performance in the assessed simulated tasks exceed what is recommended and what is possible during surgical training programs in some countries.

Arthroscopy Volume in United States Residency Programs: Are New Trainees Prepared?

“…Specifically, the authors noted that 78 arthroscopic procedures of any kind were necessary to achieve competency in basic diagnostic hip arthroscopy performed on a simulator, whereas more than 610 arthroscopic procedures were necessary to obtain mastery of hip arthroscopy techniques. 10 Similarly, Middleton et al 11 found a threshold of 52 arthroscopic procedures required for competence in basic diagnostic tasks on a shoulder arthroscopy simulator. Furthermore, 248 arthroscopic procedures were required for competence performing a complex task, whereas 476 procedures were required for expertise in complex tasks.…”

“…Furthermore, 248 arthroscopic procedures were required for competence performing a complex task, whereas 476 procedures were required for expertise in complex tasks. 11 Price et al 16 demonstrated a significant increase in arthroscopic performance of trainees with increasing experience. The authors discussed that $170 prior arthroscopies were necessary to perform a diagnostic knee arthroscopy at the level of a staff surgeon.…”

“…There remains a significant disparity between the experience thresholds recommended in the aforementioned learning curve studies 10,11,16 and the minimum case loge requirements established by the ACGME. Currently, the ACGME requires graduating orthopaedic surgery residents to have logged 30 knee arthroscopy cases, 20 shoulder arthroscopy cases, and 10 anterior cruciate ligament reconstructions, with a total of 60 arthroscopic or arthroscopic-assisted procedures.…”

“…10 Other data suggest that greater than 50 arthroscopies are required for competence in basic shoulder arthroscopy, approximately 250 are required for competence in complex tasks (i.e., Bankart repair), and more than 475 are required for expertise in complex tasks. 11 Previous studies have demonstrated a significant amount of variability in the number of arthroscopic surgical experiences for graduating residents between 2007 and 2013. 5,12 Additionally, as hip arthroscopy is a relatively new procedure, Accreditation Council for Graduate Medical Education (ACGME) case log data for hip arthroscopy first became available in 2012.…”

Editorial Commentary: The Arthroscopist's Baton—Can Minimizing Motion Lead to Better Outcomes?

“…Although the study by Roberts et al 5 is narrow in its conclusion, it does provide the opportunity to stimulate future research that will change how arthroscopic training is taught and evaluated. By combining the methodology of this study with future studies that include global rating scales [6][7][8]…”