Longitudinal Pilot Study on the Use of Low-Cost Modules to Improve Junior Orthopaedic Resident Surgical Skills.

Abstract

Orthopaedic skills modules have been validated in the short term, but their effect on longitudinal development is unknown. The objective of this study was to assess whether orthopaedic surgery interns with access to a home module set had improved Objective Structured Assessment of Technical Skill (OSATS) scores at the end of the academic year compared with the start of the year and with a control class who did not have access to the modules. In this prospective cohort study, eight incoming postgraduate year one residents ("PGY1") and eight outgoing PGY1 residents ("control") were tested on five skills modules. The PGY1 cohort had home access to modules over the year and was retested at the end of the academic year. Grading was conducted by two faculty using the OSATS Global Rating Score (GRS). Objective measures of efficiency (time) and accuracy were recorded. The performances of PGY1 at the beginning of the year versus the end of the year and PGY1 at the end of the year versus control group were compared. A significant improvement was observed in GRS across all modules for PGY1, and the end-of-year PGY1 performed better than the control cohort across all modules (all P < 0.05). For the PGY1 cohort, beginning-of-year versus end-of-year accuracy improved in drill plunge from 13.7 ± 8.6 to 5.7 ± 2.1 millimeters (P = 0.034) and efficiency improved in angled drilling from 37.6 ± 22.5 to 12.0 ± 3.6 seconds (P = 0.017). The end-of-year PGY1 demonstrated greater efficiency in drill plunge, depth gauge, and angled drilling compared with the control cohort (all P < 0.05), with no significant differences in task accuracy. The 1-year implementation of low-cost orthopaedic skills modules was associated with improved skill performance among the PGY1 residents relative to their performance at the beginning of the year and relative to a class of control residents who did not have access to the modules.