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Arthroscopy. 2015 Sep;31(9):1655-70. doi: 10.1016/j.arthro.2015.05.006. Epub 2015 Jul 31.

The Bankart Performance Metrics Combined With a Cadaveric Shoulder Create a Precise and Accurate Assessment Tool for Measuring Surgeon Skill.

Author information

1
ProOrtho Clinic, Kirkland, Washington, U.S.A.. Electronic address: rlamdortho@comcast.net.
2
The Ryu Hurvitz Orthopedic Clinic, Santa Barbara, California, U.S.A.
3
Professor Emeritus, University of California, Los Angeles, California, U.S.A.
4
ASSERT, University College Cork, Cork, Ireland.

Abstract

PURPOSE:

To determine if previously validated performance metrics for an arthroscopic Bankart repair (ABR) coupled with a cadaveric shoulder are a valid assessment tool with the ability to discriminate between the performances of experienced and novice surgeons and to establish a proficiency benchmark for an ABR using a cadaveric shoulder.

METHODS:

Ten master/associate master faculty from an Arthroscopy Association of North America Resident Course (experienced group) were compared with 12 postgraduate year 4 and postgraduate year 5 orthopaedic residents (novice group). Each group was instructed to perform a diagnostic arthroscopy and a 3 suture anchor Bankart repair on a cadaveric shoulder. The procedure was videotaped in its entirety and independently scored in blinded fashion by a pair of trained reviewers. Scoring was based on defined and previously validated metrics for an ABR and included steps, errors, "sentinel" (more serious) errors, and time.

RESULTS:

The inter-rater reliability was 0.92. Novice surgeons made 50% more errors (5.86 v 2.95, P = .013), showed more performance variability (SD, 1.86 v 0.55), and took longer to perform the procedure (45.5 minutes v 25.9 minutes, P < .001). The greatest difference in errors related to suture delivery and management (exclusive of knot tying) (1.95 v 0.45, P = .024).

CONCLUSIONS:

The assessment tool composed of validated arthroscopic Bankart metrics coupled with a cadaveric shoulder accurately distinguishes the performance of experienced from novice orthopaedic surgeons. A benchmark based on the mean performance of the experienced group includes completion of a 3-anchor Bankart repair, and enacting no more than 3 total errors and 1 sentinel error.

CLINICAL RELEVANCE:

Validated procedural metrics combined with the use of a cadaveric shoulder can be used to assess the performance of an ABR. The methodology used may serve as a template for outcomes-based procedural skills training in general.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01921621.

PMID:
26238730
DOI:
10.1016/j.arthro.2015.05.006
[Indexed for MEDLINE]

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