Diagnostic knee arthroscopy: a pilot study to evaluate surgical skills.
OBJECTIVE
To develop a scoring system to evaluate individual proficiency at diagnostic knee arthroscopy.


METHODS
This was a prospective blinded study. Subjects included residents in postgraduate year (PGY) 1 through PGY 5 (n = 20) and staff surgeons (n = 10). All subjects performed a diagnostic arthroscopy on a cadaveric knee. Subjects were evaluated on both completeness and time required to complete the arthroscopy. The examiner viewed the arthroscopy from a remote location and was blinded to the level of training of the subjects. During the arthroscopy, 15 areas required assessment to achieve a score of 75 points. An additional 25 points were awarded depending on the time it took to complete the arthroscopy. A maximum of 100 points were available (Total score = Arthroscopy score + Time score).


RESULTS
Thirty subjects were divided into 3 groups: group 1 (PGY 1 or 2) (n = 12), group 2 (PGY 3, 4, or 5) (n = 8), and group 3 (staff) (n = 10). In group 1 the mean total score was 28.25 points, the mean time to complete arthroscopy was 11.9 minutes, and the mean number of structures not examined was 8.67. In group 2 the mean total score was 76 points, the mean time to complete arthroscopy was 8.2 minutes, and the mean number of structures not examined was 1.75. In group 3 the mean total score was 100 points, the mean time to complete arthroscopy was 4.6 minutes, and the mean number of structures not examined was 0. Statistically significant differences by use of an analysis of variance test were noted for the total score, total time, and number of missed structures (P < .001).


CONCLUSIONS
Using our skills assessment tool, we were able to evaluate subjects and determine their relative technical skill level in performing a diagnostic arthroscopy. This tool was able to distinguish among the novice, experienced, and expert levels in performing diagnostic arthroscopy.


METHODS
Level III, development of diagnostic criteria on the basis of consecutive subjects.
Department of Surgery, University of California, San Francisco, San Francisco, California, USA. melliott@childrenscentralcal.org
Michael J
MJ
Elliott
Peter A
PA
Caprise
Amy E
AE
Henning
Christopher A
CA
Kurtz
Jon K
JK
Sekiya
D001182:Arthroscopy; D002102:Cadaver; D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D007719:Knee Joint / Q000473:pathology*; D009985:Orthopedics / Q000193:education*; D010865:Pilot Projects