title: The Bankart Performance Metrics Combined With a Shoulder Model Simulator Create a Precise and Accurate Training Tool for Measuring Surgeon Skill.
abstract: OBJECTIVE
  To determine if a dry shoulder model simulator coupled with previously validated performance metrics for an arthroscopic Bankart repair (ABR) would be a valid tool with the ability to discriminate between the performance of experienced and novice surgeons, and to establish a proficiency benchmark for an ABR using a model simulator.
  
  
  METHODS
  We compared an experienced group of arthroscopic shoulder surgeons (Arthroscopy Association of North America faculty) (n = 12) with a novice group (n = 7) (postgraduate year 4 or 5 orthopaedic residents). All surgeons were instructed to perform a diagnostic arthroscopy and a 3 suture anchor Bankart repair on a dry shoulder model. Each procedure was videotaped in its entirety and scored in blinded fashion independently by 2 trained reviewers. Scoring used previously validated metrics for an ABR and included steps, errors, and "sentinel" (more serious) errors.
  
  
  RESULTS
  The inter-rater reliability among pairs of raters averaged 0.93. The experienced group made 63% fewer errors, committed 79% fewer sentinel errors, and performed the procedure in 42% less time than the novice group (all significant differences). The greatest difference in errors between the groups involved anchor preparation and insertion, suture delivery and management, and knot tying.
  
  
  CONCLUSIONS
  The tool comprised by validated ABR metrics coupled with a dry shoulder model simulator is able to accurately distinguish between the performance of experienced and novice orthopaedic surgeons. A performance benchmark based on the mean performance of the experienced group includes completion of a 3 anchor Bankart repair, enacting no more than 4 total errors and 1 sentinel error.
  
  
  CONCLUSIONS
  The combination of performance metrics and an arthroscopic shoulder model simulator can be used to improve the effectiveness of surgical skills training for an ABR. The methodology used may serve as a template for outcomes-based procedural skills training in general.
authors.affiliation: ProOrtho Clinic, Kirkland, Washington, U.S.A.. Electronic address: rlamdortho@comcast.net.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Angelo
authors.affiliation: Professor Emeritus, University of California, Los Angeles, California, U.S.A.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pedowitz
authors.affiliation: The Ryu Hurvitz Orthopedic Clinic, Santa Barbara, California, U.S.A.
authors.forename: Richard K N
authors.initials: RK
authors.lastname: Ryu
authors.affiliation: ASSERT, University College Cork, Cork, Ireland.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Gallagher
mesh_terms: D001182:Arthroscopy / Q000193:education* / Q000379:methods; D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D004521:Educational Measurement; D006801:Humans; D008953:Models, Anatomic; D019637:Orthopedic Procedures / Q000193:education; D011597:Psychomotor Performance; D015203:Reproducibility of Results; D045442:Rotarod Performance Test; D012782:Shoulder / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques