The dawn of a new competency-based training era

James, Hannah; Gregory, Robert J.

doi:10.1302/2633-1462.23.bjo-2020-0155.r1

Cited by 17 publications

(17 citation statements)

References 47 publications

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“…The number of foundation programme doctors pursuing higher training in orthopaedics has steadily declined, with the experience of foundation doctors and medical students having a significant impact on career path after completion of their foundation training. [30][31][32] The reforms to undergraduate orthopaedic training, along with appropriate supplementation at the postgraduate stage, will be vital in enticing graduates into a career in this field to ensure the maintenance of adequate musculoskeletal care provision in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Potentially, looking forward to how higher orthopaedic training is adapting to reduced working hours and increased training demands, using methods such as simulation may provide useful suggestions for undergraduate teaching. 30 , 31 The current evidence base suggests that interactive, patient- or case-focused, senior-led bedside and small group teaching provides students with the most educational value for the time invested.…”

Section: Discussionmentioning

confidence: 99%

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Undergraduate education of trauma and orthopaedic surgery in the UK

et al. 2022

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Aims Evidence exists of a consistent decline in the value and time that medical schools place upon their undergraduate orthopaedic placements. This limited exposure to trauma and orthopaedics (T&O) during medical school will be the only experience in the speciality for the majority of doctors. This review aims to provide an overview of undergraduate orthopaedic training in the UK. Methods This review summarizes the relevant literature from the last 20 years in the UK. Articles were selected from database searches using MEDLINE, EMBASE, ERIC, Cochrane, and Web of Science. A total of 16 papers met the inclusion criteria. Results The length of exposure to T&O is declining; the mean total placement duration of two to three weeks is significantly less than the four- to six-week minimum advised by most relevant sources. The main teaching methods described in the literature included didactic lectures, bedside teaching, and small group case-based discussions. Students preferred interactive, blended learning teaching styles over didactic methods. This improvement in satisfaction was reflected in improvements in student assessment scores. However, studies failed to assess competencies in clinical skills and examinations, which is consistent with the opinions of UK foundation year doctors, approximately 40% of whom report a “poor” understanding of orthopaedics. Furthermore, the majority of UK doctors are not exposed to orthopaedics at the postgraduate level, which only serves to amplify the disparity between junior and generalist knowledge, and the standards expected by senior colleagues and professional bodies. Conclusion There is a deficit in undergraduate orthopaedic training within the UK which has only worsened in the last 20 years, leaving medical students and foundation doctors with a potentially significant lack of orthopaedic knowledge. Cite this article: Bone Jt Open 2022;3(7):549–556.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Undergraduate education of trauma and orthopaedic surgery in the UK

et al. 2022

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“…FPA is an attractive candidate outcome measure for simulation-based studies where assessment of skill transfer from the laboratory to real-world practice is required. It may also have applicability in the modern competence-based training climate, 3 where the procedure-based assessment (PBA) has recognized limitations. 4,5 Assessment of technical skill in the real-world clinical environment has significant known methodological challenges, a recent large systemic review 1 showed that none of the technical skill assessment tools currently in use in orthopaedic training across the world satisfy the Norcini criteria 6 for effective assessment.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessing technical skill in ankle fracture surgery from the postoperative radiograph

2022

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Aims To identify a core outcome set of postoperative radiographic measurements to assess technical skill in ankle fracture open reduction internal fixation (ORIF), and to validate these against Van der Vleuten’s criteria for effective assessment. Methods An e-Delphi exercise was undertaken at a major trauma centre (n = 39) to identify relevant parameters. Feasibility was tested by two authors. Reliability and validity was tested using postoperative radiographs of ankle fracture operations performed by trainees enrolled in an educational trial (IRCTN 20431944). To determine construct validity, trainees were divided into novice (performed < ten cases at baseline) and intermediate groups (performed ≥ ten cases at baseline). To assess concurrent validity, the procedure-based assessment (PBA) was considered the gold standard. The inter-rater and intrarater reliability was tested using a randomly selected subset of 25 cases. Results Overall, 235 ankle ORIFs were performed by 24 postgraduate year three to five trainees during ten months at nine NHS hospitals in England, UK. Overall, 42 PBAs were completed. The e-Delphi panel identified five ‘final product analysis’ parameters and defined acceptability thresholds: medial clear space (MCS); medial malleolar displacement (MMD); lateral malleolar displacement (LMD); tibiofibular clear space (TFCS) (all in mm); and talocrural angle (TCA) in degrees. Face validity, content validity, and feasibility were excellent. PBA global rating scale scores in this population showed excellent construct validity as continuous (p < 0.001) and categorical (p = 0.001) variables. Concurrent validity of all metrics was poor against PBA score. Intrarater reliability was substantial for all parameters (intraclass correlation coefficient (ICC) > 0.8), and inter-rater reliability was substantial for LMD, MMD, TCA, and moderate (ICC 0.61 to 0.80) for MCS and TFCS. Assessment was time efficient compared to PBA. Conclusion Assessment of technical skill in ankle fracture surgery using the first postoperative radiograph satisfies the tested Van der Vleuten’s utility criteria for effective assessment. 'Final product analysis' assessment may be useful to assess skill transfer in the simulation-based research setting. Cite this article: Bone Jt Open 2022;3(6):502–509.

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“…It is a completely different way to think about training. I would recommend all UK-based readers (and those overseas with an interest in training) read the excellent summary from James et al, 1 which sets everything into context.…”

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confidence: 99%

What lies beneath: major training changes during the pandemic

Ollivere¹

2022

Bone & Joint 360

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The dawn of a new competency-based training era

Cited by 17 publications

References 47 publications

Undergraduate education of trauma and orthopaedic surgery in the UK

Undergraduate education of trauma and orthopaedic surgery in the UK

Assessing technical skill in ankle fracture surgery from the postoperative radiograph

What lies beneath: major training changes during the pandemic

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