Assessing Improvement in Diagnostic Knee Arthroscopic Skill During the AAOS Fundamentals of Knee and Shoulder Arthroscopy Course for Orthopaedic Residents

OBJECTIVES: The purpose of the AAOS Fundamentals of Knee and Shoulder Arthroscopy Course for Orthopaedic Residents is to provide an opportunity for orthopaedic trainees to practice and improve basic arthroscopic surgical skills. During the course, residents spend the majority of their time in the Orthopaedic Learning Center laboratory performing basic arthroscopic procedures on cadaveric specimens under the direction of an expert faculty. Residents are also exposed to various didactic lectures during this intensive three-day course. Historically, feedback from the course has been extremely positive from both resident participants and faculty, however no attempt has previously been made to more objectively determine the degree to which improvement in resident skill has occurred. The purpose of this study is to determine whether participation in the AAOS Fundamentals of Arthroscopic Surgery Course for Residents led to improved diagnostic knee arthroscopy performance. We hypothesized that scores on post course assessments of knee arthroscopy skills and confidence would be higher in comparison to scores on the same assessments prior to the course. METHODS: 46 orthopaedic surgical residents enrolled in the AAOS Fundamentals of Arthroscopic Surgery Course volunteered to participate in the study. Participants were asked to perform a diagnostic knee arthroscopy on a cadaveric knee specimen both before and immediately after the conclusion of the knee portion of the course. Diagnostic knee arthroscopy performance was assessed using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Residents were also assessed before and after the course using the TolTech virtual reality simulator which enables the objective assessment of several measures that correlate with arthroscopic proficiency. Confidence, before and after the course, for several arthroscopic procedures was also assessed via a self-reported questionnaire. RESULTS: Following the course, residents demonstrated a 9.2% improvement in mean ASSET score (p=0.001). ASSET score improved most (13.2%) for those with less than 20 arthroscopic cases (p=0.007). On the TolTech virtual reality simulator, mean scores demonstrated significant improvements for multiple measures of proficiency including: Time, which improved 18% (p=.01), Arthroscope path distance, which improved 13% (p=.02), Probe path distance, which improved 16% (p=.05), Smoothness, which improved 10% (p=.001), and excessive probe pressure, which improved 440% (p=.02). Overall completeness improved 1.8%, but this was not significant (p=0.11). Confidence in performing arthroscopic partial menisectomy improved 13% (p=.002) and confidence in performing ACL reconstruction improved 9% (p=.01).(Table 1). CONCLUSION: It was feasible to assess several outcomes related to resident proficiency and confidence within the structure of the AAOS Fundamentals of Arthroscopic Surgery Course. Resident participation in the course resulted in modest improvements for many of the outcomes measured demonstrating the value of this and similar courses. This data will be critically evaluated to determine curricular changes in an effort to maximize course benefit for future participants.