Authors' Reply

Abstract

We appreciate Dr. Pedowitz's thoughtful comments regarding our article. We agree that operative caseload is, unfortunately at times, used as a surrogate for the evaluation of technical proficiency.1Malangoni M.A. Biester T.W. Jones A.T. Klingensmith M.E. Lewis Jr., F.R. Operative experience of surgery residents: Trends and challenges.J Surg Educ. 2013; 70: 783-788Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar The article also notes the limitations of solely assessing resident competency using such a method. We also share your enthusiasm regarding the implementation of arthroscopic skill simulators as safe methods by which to improve the arthroscopic technique among residents and as a possible means of skill assessment. However, improvement in the uniformity of outcome reporting after arthroscopic simulation training is needed.2Hetaimish B, Elbadawi H, Ayeni OR. Evaluating simulation in training for arthroscopic knee surgery: A systematic review of the literature [published online March 27, 2016]. Arthroscopy. doi:10.1016/j.arthro.2016.01.012.Google Scholar The Accreditation Council for Graduate Medical Education Orthopaedic Surgery Milestone project, which aims to evaluate proficiency in the assessment and treatment of 16 distinct orthopaedic pathologies including anterior cruciate ligament injuries, meniscal tears, and rotator cuff injuries, may aid in the reduction of reliance on case volume for assessment of competency.3Accreditation Council for Graduate Medical Education. ACGME orthopaedic surgery milestones. http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/OrthopaedicSurgeryMilestones.pdf. Published 2013. Accessed May 3, 2016.Google Scholar, 4Bradley K.E. Andolsek K.M. A pilot study of orthopaedic resident self-assessment using a milestones' survey just prior to milestones implementation.Int J Med Educ. 2016; 7: 11-18Crossref Scopus (18) Google Scholar The next question to be answered in future studies should concern the correlation of case volume and operative competency. Rather than to perpetuate a tradition of clinical evaluation via quantity, the aim of our study was 2-fold: (1) to assess arthroscopic caseload in light of current standards and (2) to stimulate discussion concerning optimal arthroscopic education for residents. Concerning the first aim, our study provides evidence that the current standards are perhaps incongruent with efficient learning, echoing your point. We are pleased to see this current correspondence as evidence reflective of the latter aim. Regarding “Trends in Arthroscopic Procedures Performed During Orthopaedic Residency: An Analysis of Accreditation Council for Graduate Medical Education Case Log Data”ArthroscopyVol. 32Issue 7PreviewI read with great interest the recent article by Hinds et al. titled “Trends in Arthroscopic Procedures Performed During Orthopaedic Residency: An Analysis of Accreditation Council for Graduate Medical Education Case Log Data.”1 I congratulate the authors for collating and reporting available information regarding recent trends in arthroscopy caseloads for US orthopaedic surgery residents. It would appear from the self-reported case logs that American orthopaedic residents are exposed to a substantial number of knee and shoulder arthroscopies during training, with relatively few exposures to arthroscopy of the other joints. Full-Text PDF Trends in Arthroscopic Procedures Performed During Orthopaedic Residency: An Analysis of Accreditation Council for Graduate Medical Education Case Log DataArthroscopyVol. 32Issue 4PreviewTo analyze orthopaedic resident case log data to report temporal trends in performing arthroscopic procedures and to assess variability in arthroscopic case volume among residents. Full-Text PDF