A Curriculum for Teaching the Foundation Tool Skills to First-Year Orthopaedic Surgery Residents

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Background: In an effort to satisfy the American Board of Orthopaedic Surgery (ABOS) requirement for a month-long orthopaedic skills rotation, programs often construct a skills curriculum that is procedurally based. As an alternative, we describe a skills program that teaches individual tool skills to fluency (accuracy at speed) using instructional modules that are innovative, challenging, inexpensive, and when combined with an operant learning program, encourage deliberate practice. Methods: The orthopaedic faculty identified 14 surgical tools that postgraduate year one (PGY-1) orthopaedic residents should use fluently before encountering them in the operating room. A curriculum was designed to teach the foundation and component behaviors necessary to achieve fluency. The curriculum was composed of 16 modules and 72 sub-modules and was presented to the 2014 and 2015 PGY-1 orthopaedic residents during a 1-month dedicated rotation (July 2014 and July 2015). Upon completion of the first rotation, the six members of the 2014 PGY-1 class were asked to complete timed tasks to evaluate their skills. Both the 2014 and 2015 classes were asked to fill out a detailed survey evaluating the tool modules and the module instructors. The costs of the modules were recorded. Results: All six members of the 2014 PGY-1 class completed all of their timed tasks. One resident did not successfully perform one of four knot tying tasks and another resident did not successfully perform a drill task. Twelve residents, (all six members of both the 2014 and 2015 PGY-1 classes) completed the survey. All of the 2015 class (6/6) considered themselves comfortable with at least half of the tools, and five of the six members of the 2015 class were comfortable with all of the tools. The survey also indicated that teachers successfully communicated the goals of the modules, gave clear instructions and contributed to the module’s success. The total cost for the skills month, for six residents, was $11,730 ($122/resident/module). Conclusions: A curriculum was designed to teach PGY-1 orthopaedic residents the foundation skills necessary to use 14 orthopaedic tools fluently. The objective of teaching the foundation and complex behaviors required to use the 14 selected tools was achieved. That goal was accomplished using a precisely defined curriculum in a supportive environment that enabled deliberate practice. It was done in a way that was cost-effective and easily reproduced at other academic institutions. However, it still must be determined if these acquired skills transfer to environments outside the laboratory.