A Proficiency-Based Progression Training Curriculum Coupled With a Model Simulator Results in the Acquisition of a Superior Arthroscopic Bankart Skill Set.
OBJECTIVE
To determine the effectiveness of proficiency-based progression (PBP) training using simulation both compared with the same training without proficiency requirements and compared with a traditional resident course for learning to perform an arthroscopic Bankart repair (ABR).


METHODS
In a prospective, randomized, blinded study, 44 postgraduate year 4 or 5 orthopaedic residents from 21 Accreditation Council for Graduate Medical Education-approved US orthopaedic residency programs were randomly assigned to 1 of 3 skills training protocols for learning to perform an ABR: group A, traditional (routine Arthroscopy Association of North America Resident Course) (control, n = 14); group B, simulator (modified curriculum adding a shoulder model simulator) (n = 14); or group C, PBP (PBP plus the simulator) (n = 16). At the completion of training, all subjects performed a 3 suture anchor ABR on a cadaveric shoulder, which was videotaped and scored in blinded fashion with the use of previously validated metrics.


RESULTS
The PBP-trained group (group C) made 56% fewer objectively assessed errors than the traditionally trained group (group A) (P = .011) and 41% fewer than group B (P = .049) (both comparisons were statistically significant). The proficiency benchmark was achieved on the final repair by 68.7% of participants in group C compared with 36.7% in group B and 28.6% in group A. When compared with group A, group B participants were 1.4 times, group C participants were 5.5 times, and group C(PBP) participants (who met all intermediate proficiency benchmarks) were 7.5 times as likely to achieve the final proficiency benchmark.


CONCLUSIONS
A PBP training curriculum and protocol coupled with the use of a shoulder model simulator and previously validated metrics produces a superior arthroscopic Bankart skill set when compared with traditional and simulator-enhanced training methods.


CONCLUSIONS
Surgical training combining PBP and a simulator is efficient and effective. Patient safety could be improved if surgical trainees participated in PBP training using a simulator before treating surgical patients.
ProOrtho Clinic, Kirkland, Washington, U.S.A.. Electronic address: rlamdortho@comcast.net.
Richard L
RL
Angelo
The Ryu Hurvitz Orthopedic Clinic, Santa Barbara, California, U.S.A.
Richard K N
RK
Ryu
Private Practice, Culver City, California, U.S.A.
Robert A
RA
Pedowitz
Tuckahoe Orthopedics, Richmond, Virginia, U.S.A.
William
W
Beach
Southern California Orthopaedic Institute, Van Nuys, California, U.S.A.
Joseph
J
Burns
Mid-Michigan Physicians, East Lansing, Michigan, U.S.A.
Julie
J
Dodds
Mississippi Sports Medicine and Orthopaedic Clinic, Jackson, Mississippi, U.S.A.
Larry
L
Field
Southern California Orthopaedic Institute, Van Nuys, California, U.S.A.
Mark
M
Getelman
Mississippi Sports Medicine and Orthopaedic Clinic, Jackson, Mississippi, U.S.A.
Rhett
R
Hobgood
Westchester Orthopaedics, White Plains, New York, U.S.A.
Louis
L
McIntyre
ASSERT, University College Cork, Cork, Ireland.
Anthony G
AG
Gallagher
D000328:Adult; D001182:Arthroscopy / Q000193:education* / Q000592:standards; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009656:North America; D009985:Orthopedics / Q000193:education; D011446:Prospective Studies; D012782:Shoulder / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D000066908:Simulation Training / Q000379:methods*; D053441:Suture Anchors