title: Do orthopaedic fracture skills courses improve resident performance?
abstract: BACKGROUND
  We hypothesized that resident participation in a hands-on fracture fixation course leads to significant improvement in their performance as assessed in a simulated fracture fixation model.
  
  
  METHODS
  Twenty-three junior orthopaedic surgery residents were tasked to treat radial shaft fractures with standard fixation techniques in a sawbones fracture fixation simulation twice during the year. Before the first simulation, 6 of the residents participated in a fraction fixation skills course. The simulation repeated 6 months later after all residents attended the course. Residents also completed a 15-question written examination. Assessment included evaluation of each step of the procedure, a score based on the objective structured assessment of technical skill (OSATS) system, and grade on the examination. Comparisons were made between the two cohorts and the two testing time points.
  
  
  RESULTS
  Significant improvements were present in the percentage of tasks completed correctly (64.1% vs 84.3%) the overall OSATS score (13.8 vs 17.1) and examination correct answers (8.6 vs 12.5) for the overall cohort between the two testing time points (p<0.001, p<0.03, p<0.04 respectively). Residents who had not participated in the surgical skills course at the time of their initial simulation demonstrated significant improvements in percentage of tasks completed correctly (61.3% vs 81.2%) and OSATS score (12.4 vs 17.0) (p<0.002, p<0.01 respectively). No significant difference was noted in performance for the cohort who had already participated in the course (p=0.87 and p=0.68). The cohort that had taken the course prior to the initial simulation showed significantly higher scores at initial evaluation (88.5% vs 58.5% percentage of tasks completed correctly, 17.3 vs 12.0 OSATS score, 12.5 vs 8.6 correct answers on the examination). At the second simulation, no significant difference was seen with task completion or examination grade, but a significant difference still existed with respect to the OSATS score (20.0 vs 17.0; p<0.03).
  
  
  CONCLUSIONS
  Participation in a formal surgical skills course significantly improved practical operative skills as assessed by the simulation. The benefits of the course were maintained to 6 months with residents who completed the training earlier continuing to demonstrate an advantage in skills. Such courses are a valuable training resource which directly impact resident performance.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, United States. Electronic address: Kenneth.egol@nyumc.org.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, United States.
authors.forename: Donna
authors.initials: D
authors.lastname: Phillips
authors.affiliation: Department of Simulation Center, New York Simulation Center for the Health Sciences, NYU Langone Medical Center, United States.
authors.forename: Tom
authors.initials: T
authors.lastname: Vongbandith
authors.affiliation: NY Simulation Center for the Health Sciences, NYU Langone Medical Center, United States.
authors.forename: Demian
authors.initials: D
authors.lastname: Szyld
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, United States.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Strauss
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000706:statistics & numerical data*; D004521:Educational Measurement; D005592:Fracture Fixation / Q000193:education* / Q000592:standards; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D009985:Orthopedics / Q000193:education*; D016544:Patient Simulation; D015203:Reproducibility of Results; D014481:United States / Q000453:epidemiology
keywords: Education; Performance; Resident; Surgical skills course; Training