title: The Bankart Performance Metrics Combined With a Cadaveric Shoulder Create a Precise and Accurate Assessment Tool for Measuring Surgeon Skill.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
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: The Ryu Hurvitz Orthopedic Clinic, Santa Barbara, California, U.S.A.
authors.forename: Richard K N
authors.initials: RK
authors.lastname: Ryu
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: ASSERT, University College Cork, Cork, Ireland.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Gallagher
mesh_terms: D001182:Arthroscopy / Q000193:education* / Q000379:methods; D002102:Cadaver; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D006801:Humans; D019637:Orthopedic Procedures / Q000193:education; D011597:Psychomotor Performance; D015203:Reproducibility of Results; D012782:Shoulder / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D053441:Suture Anchors