Response to operative experience in paediatric orthopaedics in UK trainees achieving a Certificate of Completion of Training in trauma and orthopaedic surgery: a descriptive analysis of national e-logbook data.

The Trauma and Orthopaedic curriculum set by the Joint Committee on Surgical Training (JCST) requires that consultant orthopaedic surgeons must have sufficient experience managing children's orthopaedic conditions. In this study, our objective was to describe the paediatric operative exposure of United Kingdom (UK)-trained orthopaedic registrars who obtain a Certificate of Completion of Training (CCT). This was a national retrospective cohort study of UK trainees obtaining a CCT between 1 January 2018 and 1 January 2024. ELogbook data for 884 trainees were obtained from the JCST, with 1,994,235 recorded operations. Descriptive analysis was performed on the operative data. Our results demonstrated that the median number of cases per trainee throughout training decreased each year across both adult and paediatric experience. The proportion of paediatric cases (age <17 years) within the trainees' logbooks remained constant at 11%. Trainees recorded a higher number of cases of paediatric trauma than elective cases, particularly surgery for forearm, wrist and supracondylar fractures. Trainees infrequently performed surgery for lower limb trauma, emergencies such as musculoskeletal infection and paediatric elective procedures. Paediatric orthopaedics is an integral part of orthopaedic training. Our results suggest that paediatric orthopaedic experience at CCT may not satisfy the requirements of the JCST curriculum. Future curriculum adjustments and additional training methods may be required to ensure trainees obtain the necessary experience to meet both the JCST standards and the demands of paediatric trauma care.

INTRODUCTION The COVID-19 pandemic has had a significant impact on training in trauma and orthopaedic surgery owing to redeployment and reductions in both trauma referrals and elective service provision. While trainee surveys have reported reduced operative experience during this period, the case deficit has not previously been quantified. METHODS An analysis was undertaken of surgical logbooks from trauma and orthopaedic registrars in the Severn Deanery. A predictive model of pre-COVID monthly cases was fitted using trainee grade, hospital, subspecialty, clinical commitment and time of the year. This model was used to predict expected monthly cases for trainees’ post-COVID rotations, which were compared with the cases actually performed. A similar analysis was undertaken to assess primary surgeon operating. RESULTS A total of 28,998 cases performed by 34 registrars between 2015 and 2021 were analysed. The COVID-19 pandemic led to an immediate and profound reduction in trainee operating, which had not fully recovered by September 2021. The average deficit accumulated over the 18 months following the onset of the pandemic was 87 cases. The accumulated deficit in trainee operating corresponds to 3–4 months of work at 300 cases per year. Deficits were accrued unequally between hospitals and subspecialties, indicating that recovery efforts will need to be individualised according to trainee experience during the pandemic. CONCLUSIONS Action is urgently required not only to restore operative training in trauma and orthopaedic surgery but also to compensate for the deficit during the current training cycle.

Currently, most surgeons pursue subspecialty fellowship training. This study answers the following questions: (1) How does the rate of fellowship training in orthopedic surgery compare with that in other surgical specialties? (2) To what extent did adoption of Accreditation Council for Graduate Medical Education (ACGME) accreditation change from 2013 to 2021? Orthopedic subspecialties were analyzed for total number of fellowship programs and positions in the 2013 and 2021 Match. Rates of ACGME accreditation were analyzed via chi-square tests. In 2021, orthopedic surgery had the highest rate of fellowship selection (94%) relative to general surgery (77%), ophthalmology (66%), plastic surgery (63%), and otolaryngology (55%). Across all orthopedic subspecialties, the percentage of ACGME accreditation decreased among fellowship programs (53% in 2013 to 48% in 2021, P=.166) and positions (58% in 2013 to 50% in 2021, P<.001). Orthopedic sports medicine had the highest adoption of ACGME accreditation (100%), followed by hand surgery (99%), musculoskeletal oncology (67%), and pediatric orthopedics (56%). Significant increases in the adoption of ACGME accreditation were noted for orthopedic sports medicine (93% in 2013 to 100% in 2021, P=.016) and hand surgery (81% in 2013 to 99% in 2021, P<.001). There was a significant decrease in ACGME accreditation for adult reconstructive orthopedics (40% in 2013 to 24% in 2021, P=.042), driven by the increase in unaccredited fellowship programs. Accreditation of orthopedic subspecialty fellowship training has decreased with respect to the proportion of accredited training positions. More research is needed to understand the benefits of ACGME accreditation for fellowship training in orthopedic surgery. [Orthopedics. 2024;47(1):57-63.].

A record of operative experience has always been a prerequisite for basic and higher surgical trainees. Although such records are usually examined during trainee assessments and hospital inspections, there has not hitherto been a systematic attempt to interrogate this data, which importantly

Trauma and Orthopedic Surgery Curriculum Concordance: An Operative Learning Curve Trajectory Perspective

Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme

Introduction:Over the past two decades, various factors have led to fewer opportunities for hands-on learning in the operating room among orthopaedic surgery trainees. Innovative training platforms using anatomic models, cadaveric specimens, and augmented reality have been devised to address this deficiency in surgical training, but such training tools are often costly with limited accessibility. Cognitive training is a low-cost training technique that improves physical performance by refining the way in which information is mentally processed and has long been used by professional athletes and world-class musicians. More recently, cognitive training tools have been developed for several orthopaedic surgery procedures, but the overall utility of cognitive training in orthopaedic surgery remains unknown.Methods:The purpose of this study was to review the existing literature regarding the use of cognitive training in orthopaedic surgery and to summarize the results of investigations comparing cognitive training tools with other methods of learning. To that effect, the PubMed and Embase databases were systematically reviewed for articles related to cognitive training in orthopaedic surgery.Results:Eleven publications met the inclusion criteria, including six randomized controlled trials. Cognitive task analysis and mental rehearsal were the most common forms of cognitive training identified. All 11 publications supported the use of cognitive training in orthopaedic surgery training. In the six randomized controlled trials, the utilization of cognitive training was associated with notably improved surgical performance and increased knowledge compared with traditional methods of learning.Discussion:Based on the limited evidence presented in this review, cognitive training represents a promising, low-cost adjunct to traditional orthopaedic surgery training. Further efforts should be directed at developing and evaluating additional cognitive training tools for orthopaedic surgery trainees.

Impact of Specialty on Cases Performed During Spine Surgery Training in the United States

Trends of Underrepresented Minorities and Female Trainees in Orthopedic, Plastic, and Hand Surgery: Did We Do Better in 2023?

PROBLEMS WITH ORTHOPEDIC SURGERY TRAINING IN PAKISTAN

Effectiveness of Virtual Reality Training in Orthopaedic Surgery

Low-Fidelity Arthroscopic Simulation Training in Trauma and Orthopaedic Surgery: A Systematic Review of Experimental Studies

Traditionally, the UK and Ireland have followed the same postgraduate surgical training of orthopaedic surgeons. Modernising medical careers (MMC) and European Working Time Directive (EWTD) have radically changed the way surgical training is delivered in the UK. In Ireland, however, the traditional structure of surgical training system continues with an emphasis to modernise the training with more objective assessment tools. The aim of this review is to highlight the current differences in the higher surgical training in Orthopaedics in the UK and Ireland.

AimIn an era of budget tightening and work-hour guideline reductions that have significantly reduced surgical exposure, low-fidelity arthroscopic simulators have an essential role to play in surgical training. The COVID-19 pandemic has only further amplified the need for alternative training models, as 91% of orthopaedic trainees have had elective procedures cancelled. The purpose of this systematic review is to synopsise the limited literature regarding the effectiveness of low-fidelity training models in the instruction of novices, and to formulate recommendations for future studies.MethodThe Embase, PubMed, Web of Science and Scopus databases were electronically searched. Studies from any year that described the use of orthopaedic, low-fidelity arthroscopic training models in novice populations were included. Questionnaires, case studies and review studies were excluded. Risk of bias assessments were also conducted for all studies.Results16 studies were identified. Using the PRISMA algorithm, 6 studies were deemed relevant. A cross-study comparison revealed low-fidelity arthroscopic simulators reduced time to completion outcomes (P < 0.05), increased ASSET scores (P < 0.01) and confirmed face validity and transfer of skills (cadaver, live patients).ConclusionsLow-fidelity simulator training significantly improves the arthroscopic performance of novices, without the high setup costs and practical constraints of high-fidelity equivalents. Low-fidelity arthroscopic simulators remain a promising training apparatus in an era of reduced surgical exposure (COVID-19). We have identified the need for consistent outcome measures with greater sample sizes across future studies. We recommend the use of standardised pre-intervention teaching (e.g., ABOS curriculum) and further transference, construct, and face validity evaluations to support future result interpretations.

Scope of Virtual Reality Training in Trauma and Orthopaedic Surgery: An Experimental Study and Review of the Literature