title: Evidence-based surgical training in orthopaedics: how many arthroscopies of the knee are needed to achieve consultant level performance?
abstract: Despite being one of the most common orthopaedic operations, it is still not known how many arthroscopies of the knee must be performed during training in order to develop the skills required to become a Consultant. A total of 54 subjects were divided into five groups according to clinical experience: Novices (n = 10), Junior trainees (n = 10), Registrars (n = 18), Fellows (n = 10) and Consultants (n = 6). After viewing an instructional presentation, each subject performed a simple diagnostic arthroscopy of the knee on a simulator with visualisation and probing of ten anatomical landmarks. Performance was assessed using a validated global rating scale (GRS). Comparisons were made against clinical experience measured by the number of arthroscopies which had been undertaken, and ROC curve analysis was used to determine the number of procedures needed to perform at the level of the Consultants. There were marked differences between the groups. There was significant improvement in performance with increasing experience (p < 0.05). ROC curve analysis identified that approximately 170 procedures were required to achieve the level of skills of a Consultant. We suggest that this approach to identify what represents the level of surgical skills of a Consultant should be used more widely so that standards of training are maintained through the development of an evidenced-based curriculum.
authors.affiliation: University of Oxford, Windmill Road, OX3 7LD, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Price
authors.affiliation: University of Oxford, Windmill Road, OX3 7LD, UK.
authors.forename: G
authors.initials: G
authors.lastname: Erturan
authors.affiliation: Royal London Hospital, Barts Health NHS Trust, 4 Newark Street, London, E1 2AT, UK.
authors.forename: K
authors.initials: K
authors.lastname: Akhtar
authors.affiliation: University of Oxford, Windmill Road, OX3 7LD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Judge
authors.affiliation: University of Oxford, Windmill Road, OX3 7LD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Alvand
authors.affiliation: University of Oxford, Windmill Road, OX3 7LD, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: Rees
mesh_terms: D001182:Arthroscopy / Q000193:education* / Q000592:standards; D003253:Consultants; D019317:Evidence-Based Medicine; D006801:Humans; D007719:Knee Joint; D009985:Orthopedics / Q000193:education*; D012372:ROC Curve
keywords: Knee arthroscopy; surgical simulation; surgical skill