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.
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Article Info
Publication History
Published online: December 24, 2020
Accepted:
November 13,
2020
Received:
May 2,
2020
Footnotes
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.
Identification
Copyright
© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America
