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J Orthop Surg (Hong Kong). 2012 Dec;20(3):356-60.

Does a mixed training course on the Oxford unicompartmental knee arthroplasty improve non-technical skills of orthopaedic surgeons?

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  • 1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.



To determine whether a mixed course on the Oxford unicompartmental knee arthroplasty (UKA) could improve the non-technical (cognitive) skills of performing UKA.


120 delegates consisting of consultant orthopaedic surgeons and advanced surgical trainees attended a 2-day course. 104 (87%) of the delegates had performed total knee arthroplasties, whereas 79 (66%) had performed UKAs. The course consisted of didactic lectures, interactive surgical demonstrations, and practical dry-bone skills workshops. Cognitive skills were assessed at the start (day 1) and end (day 2) of the course using 10 multiple-choice questions. The maximum test score was 10. Multilevel modelling was used to compare the pre- and post-course test scores. The pairings of pre- and post-course scores were not known because of a confidentiality clause.


Of the 120 delegates, 71 (59%) took the pre-course test and 120 (100%) took the post-course test. The median score improved significantly from 2 (interquartile range [IQR], 0.5-3.5) to 6 (IQR, 4.5- 7.5) [bootstrap p<0.0001] for every single one of the randomly allocated pairings. Most delegates had poor cognitive skills for the UKA before the course and improved significantly after the course. Sub-analysis of each question topic showed significant improvement in scores for all topics after the course (bootstrap p<0.0001). Nonetheless, the extent to which individual topic scores improved varied widely. The odds ratio for the pre- versus post-course total test score was 4.36.


A mixed continuing medical education course could enhance the non-technical (cognitive) skills for UKA.

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