Orthopaedic Curriculum Research Articles

AB168. SOH24AB_252. A novel orthopaedic curriculum is an effective teaching tool for junior trainees in Ireland

AB168. SOH24AB_252. A novel orthopaedic curriculum is an effective teaching tool for junior trainees in Ireland

What to Teach in Small Animal Veterinary Orthopedics: A Survey of Practicing Veterinarians to Inform Curriculum Development.

Competency-based veterinary education focuses on the knowledge and clinical skills required to generate a productive and confident practitioner. Accurate identification of clinically relevant core competencies enables academic institutions to prioritize which new and foundational information to cover in the limited time available. The goal of this study was to aggregate the opinions of veterinary practitioners about small animal core competencies in veterinary orthopedics. An online 20-question survey was distributed with questions regarding respondent demographics, education, practice type, caseload, involvement in orthopedic procedures, access to referral hospitals, frequency of orthopedic condition presentation and procedure performance, and proposed percent allocation of various orthopedic curriculum topics. Responses were included from 721 respondents, largely first-opinion veterinarians (81%, n = 580/721). The majority (58%; n = 418/721) of respondents performed less than 10% of the orthopedic surgeries themselves and, 37% (n = 266/721) reported never performing orthopedic surgery; of those performing surgeries, 78% (n = 354/455) performed less than six orthopedic procedures monthly. The five most common orthopedic conditions seen included: generalized osteoarthritis, patellar luxation, cranial cruciate ligament disease, hip dysplasia/arthritis, and muscle/tendon injuries. Median respondent scores for the percentage which a topic should comprise in an ideal orthopedic curriculum were 20% each for 'orthopedic exam' and for 'non-surgical orthopedic knowledge', 15% each for 'non-surgical orthopedic skills,' 'orthopedic imaging (radiographs),' and 'surgical orthopedic knowledge,' 10% for 'surgical orthopedic skills,' and 2% for 'advanced orthopedic imaging.' Based on these results, a curriculum focusing on the most clinically relevant orthopedic conditions with an emphasis on diagnosis establishment and non-surgical treatments is proposed.

OrthoACCESS: Implementing a Sub-Internship Curriculum for MS4s Applying to Orthopaedic Surgery

Medical students pursuing orthopedic surgery residency build foundational knowledge during clinical rotations. Most clinical rotations, home and away, were paused during the COVID-19 pandemic. Given the lack of structured fourth-year medical student (MS4) education for basic orthopedics, educators developed the Ortho Acting-Intern Coordinated Clinical Education and Surgical Skills (OrthoACCESS) curriculum in 2019. This study demonstrates the accessibility and usability of a MS4 virtual orthopedic curriculum and examines the curriculum's role in increasing learner familiarity with basic orthopedic topics in 2020. OrthoACCESS faculty presented weekly lectures from July to October 2020 using Zoom Webinar. Website content included recorded webinars, external resources, and skills videos. Registrants were anonymously surveyed after each webinar characterizing the knowledge and utility of individual lectures. After the webinar series, registrants were emailed an anonymous post-curriculum survey characterizing their experience using the OrthoACCESS curriculum. OrthoACCESS had 1062 registrants, with 59% (624/1,062) MS4s. 4528 users accessed the OrthoACCESS website from 66 countries. The 15 lectures were viewed 3743 times, 1553 live views and 2190 asynchronous views. 444 postwebinar surveys were completed. Weekly response rates ranged from 18% to 45%. Respondents felt more knowledgeable and more able to apply their knowledge after viewing each lecture (p < 0.001), and found the webinars to be well-organized, well-paced, enthusiastically taught, and level-appropriate. 122/976 (13%) students and 45/291 (15%) faculty completed the postcurriculum survey. Faculty reported that OrthoACCESS was "quite useful" (4 [3-5]) for providing knowledge for an incoming orthopaedic intern. Faculty and students would recommend OrthoACCESS to future learners (5 [4-5]). OrthoACCESS delivered foundational musculoskeletal instruction during a period of increased need. In its initial iteration, this virtual curriculum demonstrated high utilization in the United States and internationally and improved participants' self-reported topical knowledge and ability to apply it clinically.

Key performance and training parameters in primary total hip arthroplasty - an expert consensus using the Delphi technique.

Primary total hip arthroplasty (THA) is a commonly performed and successful operation which orthopaedic trainees must demonstrate competence in prior to completion of surgical training. An assessment of agreement between surgical trainers regarding the critical steps of a primary THA has never been undertaken. The aim of this study was to define and rank the key steps of a primary THA regards ease of teaching and their importance in achieving the best patient outcome. The Delphi technique with 3 iterative rounds was used to establish expert group consensus. The benchmark for consensus was set at an 80% agreement in any category for each step of a THR. The intra-class correlation coefficient (ICC) was used to report on the inter- and intra-rater reliabilities between and within participants responses respectively in rounds 2 and 3. 50 consultant orthopaedic hip surgeons completed round 2, and 28 completed round 3. Overall, 27 steps (54 parameters) were identified, with 16 parameters achieving consensus agreement for their impact on patient outcome, and 17 for ease of teaching. The inter-rater ICC for patient outcome parameters was 0.89 and 0.92 in rounds 2 and 3 respectively while for teaching parameters it was 0.82 and 0.73. 50% of surgeons agreed that acetabular reaming, assessing and accurately restoring leg length, and acetabular cup anteversion were the 3 most difficult steps to teach trainees, while 90% agreed these 3 steps were substantially important to patient outcome. Another 5 steps achieved consensus for their substantial impact on patient outcome but failed to achieve consensus for ease of teaching. The results of this expert consensus have produced a rank-order list of the key steps in primary THA, which may be used for orthopaedic curriculum development and guiding focused improvements for surgical training in primary THR including simulation.

Mentored undergraduate operating room teaching during the orthopedic trauma curriculum-No evidence of gender differences.

In many surgical disciplines, the interest among medical students to pursue asurgical career decreases during their medical studies. The same goes for students after graduation. The aim of our cohort study was to evaluate the operating room (OR) experiences of medical students during our curriculum. Over the course of one year 217 senior year medical students were included in our study. All of them took part in our training program for senior year medical students, which consisted of a1-week clinical rotation including visits to the OR. We developed aLikert-scaled questionnaire, which was evaluated anonymously; free text answers were also possible. Prior to the analysis of the sex and age differences, we confirmed that the evaluation scale provided acoherent measure of the OR evaluation. As afirst proxy, we conducted aseries of Spearman correlations which revealed high intercorrelations between all of the six items of the questionnaire, r(154) = 0.53 to r(154) = 0.94, all p < 0.001. These high intercorrelations transferred into avery high consistency of the six questions that evaluate the OR teaching; Cronbach's α = 0.95. There was no main effect of sex, F (1,146) = 2.19, p = 0.141. However, there was amain effect of age, F (2,146) = 3.75, p = 0.026, indicating that older participants evaluated the OR teaching more positively. Finally, there was no correlation between sex and age group, F (2,146) < 1, indicating that the effect of age on the evaluation score was equally pronounced for female and male participants. The aim of this study was to answer the question how mentored OR teaching during the orthopedic trauma curriculum is evaluated by medical students, and whether there are gender-specific differences. For this purpose we prospectively evaluated senior year medical students over aperiod of 12months during the orthopedic trauma curriculum with questionnaires. The medical students rated the mentored OR visits mainly positive. Previously published literature as well as our presented data indicate that the interest of medical students in starting asurgical career can only be increased if negative influencing factors are reduced. This includes especially positive communication with medical students and in daily professional interaction.

The dawn of a new competency-based training era.

The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical Training initiative, reflect yet another paradigm shift in the recent history of trauma and orthopaedic training. The move to outcome-based training without time constraints is a radical departure from the traditional time-based structure and represents an exciting new training frontier. This paper summarizes the history of T&O training reform, explains the rationale for change, and reflects on lessons learnt from the past.Cite this article: Bone Jt Open 2021;2-3:181–190.

Temporary external fixation in the management of orthopaedic trauma

Temporary external fixation is frequently employed nowadays in the immediate management of orthopaedic trauma. It is particularly effective in major trauma and in open fractures or periarticular fractures of the lower limb with soft tissue compromise. In addition it is used for more recent indications such as intraoperative adjuncts to internal fixation. Despite the associated complications and pitfalls described, in most cases the benefits of temporary external fixation in the initial management of injured bones and soft tissues outweigh the risks, and facilitate the eventual definitive treatment. The application of a stable external fixator construct is an essential skill for any orthopaedic surgeon who manages trauma; despite this, the skill seems to be in decline outside major trauma centres in the UK. Inclusion of external fixation in the mandatory indicative procedures of the trauma and orthopaedic curriculum serves as a useful reminder of its value.

Analysis of Reference Practices among Practicing Orthopaedicians in India.

On-The-Go (OTG) references are those that clinicians make within a tight deadline at the point of patient care to direct critical decisions. We conducted this study to assess the knowledge level of orthopaedicians on clinical usefulness and quality appraisal of different reference methods along with their attitude towards its utility for practice. A web-based survey was administered through Google Forms among the members of the Tamil Nadu Orthopaedic Association (TNOA) by snowball sampling method. The survey was designed by the Quality Appraisal Committee (QAC) of Orthopaedic Research Group (ORG) with 17 items. Association and correlation analysis were done between different responses in the survey to find out ways to improve the reference practices. 177 participants with a mean age of 43.5years completed the survey. About45.8% (n = 81) of participants had prior knowledge on the Oxford Levels of Evidence. However, they were not familiar with using them for critical appraisal of evidence. About 86.5% (n = 153) of participants were worried about the quality of the content they seek for reference. Among the reference sources, online research articles were used by 54.2% (n = 96), digital applications by 21.4% (n = 38), digital textbooks by 15.2% (n = 27), and other methods like peer discussion by 5.1% (n = 9). A significant association was noted between the participants who chose level I studies for their reference and their familiarity with the concept of fragility (p = 0.006) and heterogenicity (p = 0.021) and types of bias (p = 0.003). A significant association was noted between participants with active journal subscription and their familiarity with the concept of spin (p = 0.016) and their knowledge of the heterogeneity of study results (p = 0.019). We found a significant association between age (< 40years of age) and knowledge on various types of bias (p = 0.032), heterogenicity (p = 0.01), and fragility (p = 0.021). This is the first study on the information-seeking behaviour of the orthopaedicians. OTG references remain a part of the orthopaedic practice and are made mostly by accessing online research articles. Imparting knowledge of their quality appraisal should be an active part of the orthopaedic curriculum. This will, in turn, improve the attitude and reference practices leading to better decision-making towards patient care.

The effectiveness of surgical simulation in orthopaedic teaching and training: A literature review

This article was migrated. The article was not marked as recommended. IntroductionChanges in the way health care is delivered coupled with the advances in orthopaedic surgical techniques entails it has become more difficult for surgical trainees to develop the operative skills required within their training programme. One strategy to address this gaining increasing interest over recent years is the incorporation of simulation training within orthopaedic training programmes. The aim of this paper is to identify and review the literature which currently exists regarding the effectiveness of surgical simulation in orthopaedic teaching and training.MethodsAn electronic search of the databases MEDLINE, EMBASE, and Cochrane Library Databases was conducted from inception to February 27 2020. To identify studies exploring the effectiveness of simulation in orthopaedic teaching and training, the following key words were searched for: simulation, simulator, orthopaedic, training, teaching and trainer. This database search was supplemented by a search of the reference lists of included studies and the related articles function offered by each database.ResultsThere is evidence in the published literature to support the effectiveness of surgical simulation in orthopaedic teaching and training. Face validity, construct validity, concurrent validity and transfer validity have all been reported to varying degrees. There is currently a great deal of variation amongst published studies in terms of the outcome scores and measurements used to evaluate the effectiveness of various simulators making direct comparison between studies difficult.ConclusionOverall, there are a sufficient number of encouraging initial reports to suggest simulator training may potentially be a valuable tool for training future generations of orthopaedic surgeons. Significant work is still required however to definitively validate their use. Additional research is also needed to assess trainee and educator satisfaction with simulators, their cost effectiveness and their role within the higher surgical orthopaedic curriculum. At present, this essential data is still lacking.

Make and Break Your Own Hand: A Review of Hand Anatomy and Common Injuries.

The target audience for this small group session is emergency medicine residents, primarily for use in didactic conference. This session can also be utilized with medical students, or faculty looking to review relevant hand anatomy and common injuries. Three-dimensional (3D) printing is an emerging technology that has the ability to produce highly accurate anatomic, cellular and medical device models. Limited research has shown promise in teaching anatomy,1 congenital heart disease2 and surgical pre-operative planning.3 Despite this potential, there is sparse evidence of 3D printing emergency medicine residency education. The Model of Clinical Practice of Emergency Medicine specifies content for American Board of Emergency Medicine certification and requires proficiency in a wide breadth of medical topics including upper extremity and hand injuries.4 The concepts of hand anatomy and function rely heavily on understanding spatial relationships between bones, tendons and ligaments. The instructional strategy of working with 3D printed hand models aligns with these learning goals. This project seeks to directly incorporate 3D printing into the orthopedic curriculum of emergency medicine residents during a required weekly didactic educational session. By the end of this session, learners should be able to name and identify all bones of the hand; arrange and construct an anatomically correct bony model of the hand; build functional phalangeal flexor and extensor tendon complexes onto a bony hand model; describe the mechanism of injury, exam findings, and management of the tendon injuries Jersey finger, Mallet finger, and central slip rupture; draw/recreate injury patterns on a bony hand model; and describe the mechanism of injury, exam findings, imaging findings, and management of scapholunate dissociation, perilunate dislocation and lunate dislocation, Bennett's fracture, Rolando fracture, Boxer's fracture and scaphoid. This session was delivered in a small group session which utilized educational methods grounded in constructivist learning such as complex problem-solving, social negotiation, and spatial learning. Verbal feedback was obtained after the session. Overall learners found the session engaging, interactive, and especially useful in demonstrating relevant hand anatomy and injuries. Learners felt that hands-on experience with the hand models reinforced knowledge and helped them better identify injuries in a spatial fashion. Extremity bony trauma, dislocations/subluxations, tendon injuries.

Orthopaedic Surgery Resident Financial Literacy: An Assessment of Knowledge in Debt, Investment, and Retirement Savings

Most orthopedic residents carry significant debt and may enter their practice with little knowledge of business management, minimal retirement savings, and overall poor financial literacy. This study aimed to gauge financial literacy, debt, and retirement planning in United States orthopedic surgery residents. Willingness to participate in formalized financial education was also assessed. Eighty-five allopathic orthopedic surgery residents in the United States completed a 14-question anonymous online survey in 2016. The survey assessed demographic data, self-assessed financial knowledge, amount of credit card debt and loans, preparation for retirement, and willingness to participate in formal didactic education on these topics. Most respondents derive their financial knowledge from personal research (51%), whereas only 4 per cent have a formal curriculum. Despite most respondents reporting more than $200,000 in outstanding loans, only 31 per cent create and stick to a budget. Few programs offer retirement advice, and 48 per cent of respondents save $0 toward retirement. Eighty-five per cent of residents expressed interest in learning about personal investment, savings, and retirement planning. Orthopedic surgery residents carry significant debt and do not achieve their high-income potential until disproportionately later in life. Only 4 per cent of residents have formal training in investing, personal finance, or retirement despite a majority who desire such a curriculum. In fact, almost 75 per cent of those surveyed felt less prepared for retirement than their peers outside of medical training. This study suggests a role for formal financial education in the orthopedic curriculum to prepare residents for retirement, improve financial literacy, and enhance debt management.

Current trends in the management of flail chest and the perceived role of the surgeon

Background: Flail chest injuries typically occur in poly-traumatized patients and are often associated with prolonged hospital stays and high rates of morbidity and mortality. Despite multiple studies showing significantly improved outcomes with surgical fixation, the surgical community has been slow to adopt rib fixation as a part of practice and, as a result, many of these patients never undergo surgical fixation. Purpose: The purpose of this study is to determine the percentage of flail chest injuries that are being treated with surgical fixation in the United States. In addition, a survey of orthopedic trauma surgeons was conducted to assess their perception of the role of orthopedics in the treatment of patients with flail chest injuries. Methods: Patients diagnosed with a flail chest injury were identified using the National Inpatient Sample (NIS) database between 2001 and 2012 and divided into two groups based on whether or not surgical fixation of the chest wall was performed. In addition, we distributed a survey questionnaire to orthopedic trauma surgeons focusing on each individual's experience with rib fracture fixation both in training and practice. Results: A total of 45,202 patients with a flail chest injury were identified using the NIS database between 2001 and 2012. Of these, 2.1% underwent surgical fixation of the chest wall with an increase in rate of fixation from 0.8% to 3.3% over the study period. According to our survey, only 20% of orthopedic trauma surgeons performed any rib fracture fixation cases in training, and only 24% perform rib fracture fixation cases in their practice. Of those who do not perform rib fracture fixation, 72% would consider doing so if they received additional training on the topic. Of all participants surveyed, 60% believed that rib fracture fixation should be a part of the orthopedic residency curriculum and 89% believed that it should be a part of the orthopedic trauma fellowship curriculum. Conclusions: Very few flail chest injuries are being treated with surgical fixation despite the emerging literature showing improved outcomes when compared to nonoperative management. Our survey shows that there is significant interest in incorporating rib fracture fixation into surgeons' training curriculum, as well as providing specialized workshops for practicing surgeons. We hope this work encourages the surgical community to embrace rib fracture fixation as a part of our specialty so that patients with flail chest injuries receive optimal care.

OrthoBoard: An Orthopaedic App for Medical Education

Introduction: Use of mobile apps as a pedagogical tool in the medical education has gained popularity as mobile apps have great potentials in perpetuating clinical knowledge and skills. To leverage mobile technology in medical education, we designed a hybrid mobile app based on our undergraduate orthopaedic curriculum. Materials and Methods: The frontend was created using hybrid mobile framework to target both iOS and Android platforms. The backend is powered by Firebase (Google Inc.) to manage authentication and social messaging. The content consisted of basic orthopaedic skills, trauma and resuscitation skills, Islamic input in orthopaedic and information cheatsheets. Results: OrthoBoard is being used by IIUM medical undergraduates as an ancillary source of learning, particularly useful as quick references and visual guides for enhancing orthopaedic knowledge and performing clinical procedures. The social messaging capability built into the app serves as a platform for discussion and exchange of information. This is the first medical app, to our knowledge, that integrates orthopaedic clinical knowledge and practice as well as Islamic input in orthopaedics into teaching and learning with the integration of social messaging as a platform for enhancement of knowledge and practice. Conclusion: Use of mobile apps as pedagogical tool in the medical education will undoubtedly increase in the future. As students and teachers embrace mobile technology in and outside the classroom, better user-centric and subject-specific apps will be required to fulfil the needs. For medical educators, developing mobile apps will possibly be one of the future armamentarium in the delivery of knowledge and skills.

The value of motion lab training in the orthopaedic residency curriculum

The value of motion lab training in the orthopaedic residency curriculum

Evidence for the Need for a National Undergraduate Orthopaedic Curriculum in the UK

There is currently no national undergraduate orthopaedic curriculum. It is developed and delivered locally, derived from the experience of orthopaedic surgeons without consultation with general practitioners. This study was designed to ascertain how well the needs of orthopaedic consultants, general practitioners and medical students are currently met by the undergraduate curriculum as a baseline for future development. A survey was designed to evaluate the perceived usefulness of three teaching domains: trauma, orthopaedic surgical pathology and commonly encountered problems in primary care. Additionally, students were asked to evaluate their level of interest in learning orthopaedic surgical procedures. The questionnaire was sent to 98 final year medical undergraduates from St George’s, University of London, 50 local general practitioners and 24 local orthopaedic consultants with a 56 % (n = 55), 52 % (n = 26) and 90 % (n = 21) response rate, respectively. There was consensus across all groups regarding the importance of trauma management. In the other domains, there was a difference of opinion, with consultants and general practitioners lending greater weight to areas seen in their own practice. A significantly greater proportion of medical students (compared to general practitioners and consultants) expressed an interest in learning orthopaedic skills (P = 0.011) There is a need for an undergraduate curriculum that reflects the needs of both consultants and general practitioners. Current time constraints make it difficult to ensure adequate coverage of all aspects of the orthopaedic education in the curriculum. Devising other educational modalities such as e-learning, simulation training and the establishment of a national curriculum may provide a solution.

Validation of objective structured clinical examination for the assessment of clinical skills in the context of an orthopaedic exit exam: the Egyptian Fellowship in Orthopaedics and Trauma experience

ContextObjective structured clinical examination (OSCE) is widely adopted in medical education to assess the skills of undergraduate students and in postgraduate basic surgical examinations such as MRCS. No orthopaedic exit exam worldwide includes an OSCE component.AimsThe aim of this study was to describe validation of OSCE to assess clinical skills of final-year orthopaedic trainees appearing for the Egyptian Fellowship in Orthopaedics and Trauma (EFOT) exam.Materials and methodsThe EFOT accreditation committee developed three types of OSCE stations: history taking, clinical examination and informed consent. A pilot study was conducted in November 2011 to assess its feasibility and validity. Analysis of faculty feedback and mapping of the OSCE station bank against intended learning outcomes in the orthopaedic curriculum served as a validation tool.ResultsA total of 51 final year candidates were included in the pilot run. Sixteen faculty members, as well as candidates, participated and provided feedback. Despite introductory lectures about OSCE, only 64% of candidates and 79% of faculty agreed that they received adequate induction. Nevertheless, the majority of candidates (84-92%) and faculty (88-100%) thought that stations' instructions were clear. As an evidence of its validity, 88% of faculty agreed that OSCE, as currently set up, adequately measured candidate performance and 94% agreed that marking sheets covered relevant aspects of performance. Mapping intended learning outcomes showed that the bank covered the nine knowledge attributes in our curriculum. Relevant attributes of the skills and attitude and behaviour domains were also covered.ConclusionOSCE is a valid assessment tool that can evaluate clinical skills of orthopaedic trainees at the end of their training. Appropriate candidate, faculty and patient/actor training is fundamental.

Burnout and quality of life among orthopaedic trainees in a modern educational programme: importance of the learning climate.

We aimed to determine quality of life and burnout among Dutch orthopaedic trainees following a modern orthopaedic curriculum, with strict compliance to a 48-hour working week. We also evaluated the effect of the clinical climate of learning on their emotional well-being. We assessed burnout, quality of life and the clinical climate of learning in 105 orthopaedic trainees using the Maslach Burnout Inventory, linear analogue scale self-assessments, and Dutch Residency Educational Climate Test (D-RECT), respectively. A total of 19 trainees (18%) had poor quality of life and 49 (47%) were dissatisfied with the balance between their personal and professional life. Some symptoms of burnout were found in 29 trainees (28%). Higher D-RECT scores (indicating a better climate of learning) were associated with a better quality of life (r = 0.31, p = 0.001), more work-life balance satisfaction (r = 0.31, p = 0.002), fewer symptoms of emotional exhaustion (r = -0.21, p = 0.028) and depersonalisation (r = -0,28, p = 0.04). A reduced quality of life with evidence of burnout were still seen in a significant proportion of orthopaedic trainees despite following a modern curriculum with strict compliance to a 48-hour working week. It is vital that further work is undertaken to improve the quality of life and reduce burnout in this cohort.

Evaluation of a Revised Orthopedic Curriculum for Emergency Medicine Residents

Evaluation of a Revised Orthopedic Curriculum for Emergency Medicine Residents

Assessing Skills Decay on a Knee Arthroscopy Simulator

Performance on a VR knee arthroscopy simulator deteriorates over time if the subject does not undertake regular arthroscopy and simulation may provide a safe and effective way of preventing skills decay. We have demonstrated that training in Virtual Reality (VR) knee arthroscopy can significantly improve simulator performance compared to controls. The aim of this study is to assess whether skills decay occurs if subjects stop performing arthroscopy. 16 subjects were recruited (8 orthopaedic surgery trainees and 8 medical students or non-clinicians). All 16 subjects had previously undergone a training programme on the ARTHROMentorTM VR arthroscopy simulator consisting of standardized exercises. They had all made significant improvements in performance based on metrics provided by the simulator (time taken, distance covered by the arthroscope and hook, and roughness). These subjects were recalled after a mean period of 17 months and repeated the initial test 3 times. There was a significant deterioration in the measured parameters for all 16 subjects (p<0.03) and there was no difference between the two cohorts. There was however a significant improvement between their 1st and 3rd attempts (p<0.05) but the best score attained was still short of that achieved previously following the training programme (p=0.09). Performance on a VR knee arthroscopy simulator deteriorates over time as skills decay occurs if the subject does not undertake arthroscopy regularly. Simulation may provide a safe and effective way of preventing skills decay if trainees are unable to undertake regular arthroscopy and efforts should be made to integrate simulation into the orthopaedic curriculum.

Procedure-Based Assessment in Shoulder and Elbow Surgery

The United Kingdom Trauma and Orthopaedic curriculum, containing procedure-based assessment (PBA) was the first surgical curriculum to be published in the world. PBA are used as a record of the training experience and, over time, provides a summative record of the trainees progress in developing their competence in learning procedures and performing them to the required standard. The original 14 index procedures did not include the majority of those performed in the upper limb. The Education Committee of the British Shoulder and Elbow Society undertook to produce PBA that were relevant to their trainees. The present review describes the process by which these were developed and implemented with the aim of helping both those who use PBA and those who may be considering developing them in the future.