Orthopedic Surgery Training Research Articles

Academic Productivity of Spine Surgeons at United States Neurological Surgery and Orthopedic Surgery Training Programs

Spinal surgery is taught and practiced within 2 different surgical disciplines, neurological surgery and orthopedic surgery. We have provided a unified analysis of academic productivity measured using the h-index attributable to spine-focused faculty at U.S. residency programs. A total of 278 Accreditation Council for Graduate Medical Education training programs were assessed to identify 923 full-time faculty members with a spinal surgery designation, as defined by spine fellowship training or case volume >75% in spine surgery. The faculty were assessed with respect to academic rank, duration of practice in years, and academic productivity (h-index). The comparison showed a significantly greater mean h-index for neurological spine surgeons. The mean h-index for both disciplines increased significantly as faculty rank increased. Within the academic ranks of assistant and associate professor, neurological spine surgeons had significantly greater mean h-indexes. Neurological spine surgeons had a significantly lower practice duration. At all ranks except for assistant professor, the mean practice duration was not significantly different statistically between the neurological spine and orthopedic spine surgeons. A positive correlation between the h-index and practice duration was found for both spine surgical disciplines. The proportional odds models for neurological and orthopedic spine surgeons were moderately successful at predicting faculty rank according to the h-index. We present a unified view of academic productivity as measured by the h-index among neurosurgical and orthopedic surgery spine faculty, with some noticeable differences. These results can be used for benchmark purposes to assess the relative productivity of its faculty and could be of interest to those pursuing academic opportunities in spine surgery.

On the Reproducibility Crisis in Nanomedicine: An Interview with Sourav Bhattacharjee

Biography Sourav Bhattacharjee is a physician (MBBS) and graduated from Medical College and Hospital Kolkata (India). After postgraduate residential training in orthopedic surgery, he finished MSc in Biomolecular Sciences/Cell Biology from the Vrije Universiteit Amsterdam (2006–2008). His MSc thesis work was done in the Napier University (Edinburgh, UK). He began his PhD in the Wageningen University (The Netherlands) in 2008, which he successfully defended in 2012. Following that he worked for almost a year as postdoc in the University of Twente (The Netherlands). From March 2014, he joined UCD (Ireland) as postdoc trying to develop nanoparticulate platforms for oral insulin delivery as part of EU FP7 funded TRANS-INT consortium. From February 2016, he was appointed as Assistant Professor in the UCD where he is engaged now in developing a broad range of advanced nanobiotechnology-based and microscopic tools for effective diagnostic and therapeutic purposes in various diseases.

Academic Orthopaedic Leadership: Current Challenges and Lessons Learned

Health-care reform, market competition, cost containment, and pressure for productivity have dramatically impacted the practice of orthopaedic surgery and academic surgical training. Orthopaedic leaders and training programs are striving to identify and solve these contemporary challenges. Herein, we focus on 4 areas that currently pose important challenges to modern orthopaedic surgical departments and academic hospital systems, including the demanding and evolving skill sets that are required of physician leaders, the effects of the changing medical-legal environment on academic medicine, the impact of increased clinical productivity emphasis on surgical education, and departmental leadership transitions.

The perils of PROMs: question 5 of the Oxford Hip Score is ambiguous to 10% of English-speaking patients: a survey of 135 patients.

The Oxford Hip Score (OHS) is a commonly used patient-reported outcome measure (PROM), comprising 12 questions. We present the incidental finding that one of the 12 questions is ambiguous. As part of a 10-year follow-up of patients treated with hip resurfacing the OHS was posted to 148 patients; 135 (91%) replied. Scores were read by 2 orthopaedic surgery trainees and entered into a database. It was noted that Question 5 was frequently mis-interpreted. Thirteen patients' questionnaires (10%) showed the same inconsistency: question 5 was scored as 0 points but the other 11 questions were scored as either 3 or 4 in 97% of cases. The ethnic group of all 13 patients was recorded in hospital data as being White-British. Question 5 of the OHS is ambiguous to 10% of native English-speakers. These patients rated their hip function highly, as reflected by the fact that 97% of the questions other than question 5 scored 3 or 4, indeed 87% of them scored 4. We hypothesise that the wording of the zero score option "Not at all" is being mis-interpreted as a response indicating that the patient does not suffer any pain at all. The effect is an error of 4 points out of 48 (8%); this may under-estimate the patient's hip score. Surgeons are under great scrutiny to prove efficacy of surgical interventions; this is often provided by PROMs. We should strive to formulate the most accurate, reproducible and least ambiguous PROMs questionnaires.

Which orthopaedic trauma patients need psychiatry consultation? A single institution pilot survey study

Background: The burden of psychologic stressors among trauma patients is high, and these symptoms are often left untreated. The purpose of this study was to determine the threshold for psychiatric symptom severity for which the orthopaedic surgeon and psychiatrist believe a consultation is indicated, and to compare these thresholds between the two groups. Methods: A survey was created following multidisciplinary discussion, which consisted of ten clinical scenarios related to orthopaedic trauma patients with symptoms of common psychologic stressors. The survey was distributed to residents in the orthopaedic surgery and psychiatry programs at our institution. Participants were asked whether a psychiatry consultation was indicated. Nonparametric statistics were used to analyze differences. Qualitative data were obtained from participants to better understand trends. Results: The survey was completed by 32 trainees (82 possible, 39%). There was agreement between the groups regarding scenarios involving suicidality, drug use or withdrawal, and the capacity to consent. There was disagreement for clinical scenarios involving schizophrenia, with orthopaedic surgeons believing a psychiatry consultation was indicated significantly more often than psychiatrists, and delirium, in which orthopaedic surgeons thought that a psychiatry consultation was indicated significantly less often than psychiatrists. Conclusions: This study demonstrated disagreement between orthopaedic surgery and psychiatry trainees. Psychiatry residents may believe that some inpatient consults for psychotic patients are unnecessary, while orthopaedic residents may be under-utilizing resources for delirious patients. Further study is necessary to determine if these trends exist at the national level and if there are implications for patient outcomes.

How social media, training, and demographics influence online reviews across three leading review websites for spine surgeons.

The future of health care is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain health-care providers, for better or worse. No prior study has specifically evaluated Internet reviews of spine surgeons, determined if social media (SM) correlates with patient reviews, or evaluated Google as a physician review website. This study aimed to evaluate patient satisfaction scores for spine surgeons in Florida using leading physician ratings websites. A retrospective study was carried out. The sample comprised spine surgeons with a review on Healthgrades.com (HG), Vitals.com (V), or Google.com (G) online rating websites as of August 17, 2017. Number of ratings, number of comments, overall rating, patient-reported wait times, physician website presence, and physician SM presence were the outcome measures. Using the directory of registered North American Spine Society physicians, we identified all spine surgeons practicing in Florida (137 orthopedic trained; 78 neurosurgery trained). Surgeon demographics and ratings data were collected from three physician rating websites (HG, V, G) from July 19, 2017 to August 17, 2017. Using only the first 10 search results from Google.com we then identified if the surgeon had accounts on Facebook (FB), Twitter (TW), or Instagram (IG). Nearly every surgeon in this cohort had either an institutional or personal website (98.1%), and 38.6% had at least one SM outlet of our three reviewed. Both personal and institutional website presence significantly correlated with higher G scores. Spine surgeons with a searchable account on FB, TW, or IG made up 35.4%, 10.2%, and 0.5% of the cohort, respectively. Surgeons with an SM presence had a significantly higher number of ratings and comments on HG, V, and G, but not overall scores. In multivariable analysis, only V showed a significant inverse correlation between overall score and age, private institution, and orthopedic surgery training. Wait times >30 minutes were significantly associated with worse overall scores across all three review sites. Overall ratings between HG, V, and G all had significantly positive correlations on Pearson correlation analysis. Social media presence correlates with patient communication in the form of number of ratings and comments, yet does not impact overall scores, suggesting social media may influence patient feedback. Longer wait times are indicative of lower scores across all three platforms. Overall ratings from all three websites correlate significantly with each other, indicating agreement between physician ratings across different platforms. Understanding the factors that optimize a patient's overall experience with a physician is an important and emerging outcome measure for the future of patient-centered health care.

Second Commentary on "Partial Wrist Denervation: The Evidence Behind a Small Fix for Big Problems".

Second Commentary on "Partial Wrist Denervation: The Evidence Behind a Small Fix for Big Problems".

Variation in Spine Surgeon Selection Criteria Between Neurosurgery and Orthopedic Surgery Patients.

A cross-sectional survey study. The objective of this study is to determine if there are any differences in spine surgeon selection criteria between neurosurgery patients and orthopedic patients. The evolution of the health care delivery system has allowed for increased patient autonomy in provider selection. However, the process and criteria by which patients choose particular spine surgeons is not well understood. Furthermore, differences in physician selection criteria used by patients who present either to a neurosurgery or orthopedic spine surgeon has not been previously established. An anonymous questionnaire consisting of 26 questions was administered to 644 patients seeking treatment from either a single neurosurgery-trained or orthopedics-trained spine surgeon at an urban institution. Four questions pertained to demographic variables. Sixteen questions asked patients to rate specific spine surgeon selection criteria in terms of importance (scale, 1-10). Six questions were multiple choice, asking patients to select their preferences towards aspects of a spine surgeon. Patient responses were compared using χ analysis or Fisher exact test for categorical variables. The 3 most important factors for selecting a spine surgeon were the same for neurosurgery and orthopedic surgery patients: board certification (neurosurgery, orthopedic surgery) (9.07±2.35, 9.22±1.79), in-network provider status (8.01±3.15, 8.09±3.03), and surgeon bedside manner (7.88±2.52, 8.07±2.29). When listing their preference regarding surgeon specialty training, 82.74% of neurosurgery patients and 48.81% of orthopedic surgery patients preferred a surgeon who was trained in neurosurgery. The growth in patient autonomy within the current health care system has emphasized the importance of identifying patient preferences in the physician selection process.Board certification, in-network insurance status, and bedside manner may be the most influential factors for patients in spine surgeon selection irrespective of surgical subspecialty. Patients may also be more likely to seek spine surgeons with neurosurgery training over orthopedic surgery training. The present study provides spine surgeons a framework to improve both patient recruitment and patient satisfaction.

Canadian Orthopaedic Residents Perception of Their Needs in Elbow Surgery Teaching

Introduction: The aim of this paper is to guide training program and review course curriculum planning in elbow disorders. To this end, a nationwide email survey was administered to residents’ in orthopaedic surgery training programs.Material and Methods: The survey had 12 items that examined learning needs in several domains: assessment of acute and chronic elbow disorders, treatment of elbow disorders and the perceived effectiveness of various practical skills simulation sessions. A rank order list of learning needs was created. Results: Eighty-eight of 351 residents completed the survey (25%). Ninety percent of respondents thought that a one-day course would be helpful. The majority of residents felt comfortable evaluating acute traumatic elbow disorders. Their level of comfort was lower in treatment of elective disorders, with only 4% of residents comfortable managing posterior interosseous nerve and 5% comfortable managing chronic elbow instability. Only 24% of residents were comfortable treating terrible triad injuries.Conclusions: Residents reported a need for additional education in elbow surgery; especially for elective disorders. Educational needs were clustered in several areas including surgical approaches, ligament repair, and surgical management of fracture dislocations.

Surgical simulation training in orthopedics: current insights.

BackgroundWhile the knowledge required of residents training in orthopedic surgery continues to increase, various factors, including reductions in work hours, have resulted in decreased clinical learning opportunities. Recent work suggests residents graduate from their training programs without sufficient exposure to key procedures. In response, simulation is increasingly being incorporated into training programs to supplement clinical learning. This paper reviews the literature to explore whether skills learned in simulation-based settings results in improved clinical performance in orthopedic surgery trainees.Materials and methodsA scoping review of the literature was conducted to identify papers discussing simulation training in orthopedic surgery. We focused on exploring whether skills learned in simulation transferred effectively to a clinical setting. Experimental studies, systematic reviews, and narrative reviews were included.ResultsA total of 15 studies were included, with 11 review papers and four experimental studies. The review articles reported little evidence regarding the transfer of skills from simulation to the clinical setting, strong evidence that simulator models discriminate among different levels of experience, varied outcome measures among studies, and a need to define competent performance in both simulated and clinical settings. Furthermore, while three out of the four experimental studies demonstrated transfer between the simulated and clinical environments, methodological study design issues were identified.ConclusionOur review identifies weak evidence as to whether skills learned in simulation transfer effectively to clinical practice for orthopedic surgery trainees. Given the increased reliance on simulation, there is an immediate need for comprehensive studies that focus on skill transfer, which will allow simulation to be incorporated effectively into orthopedic surgery training programs.

Algorithms for Clinical Indications of Bone Substitutes - Component of Training in Orthopaedic Surgery

Modern traumatology is characterised by increasingly severe injuries, with significant soft tissue and bone loss; therefore, restoration of functional anatomy regards bone filling with proper bone integration, and otherwise surgical reconstruction is useless. Therefore, orthopaedic surgeons must have not only surgical skills, but thorough knowledge about the properties and indications of bone substitutes, which can improve surgical results in treating especially comminuted fractures. Integrating the clinical experience from a Level 1 Trauma Centre with didactic principles, and using e-learning as an educational tool, this paper refers to establishing an algorithm of clinical indications of bone substitutes in orthopaedic surgery and to introducing it into the educational process of orthopaedic trainees, as a component of vocational training.

Clinical Skills and Professionalism: Assessing Orthopaedic Residents With Unannounced Standardized Patients

We developed a series of orthopedic unannounced standardized patient (USP) encounters for the purpose of objective assessment of residents during clinic encounters. Consecutive case-series. NYU-Langone Multi-center Academic University Hospital System. NYU-Langone/Hospital for Joint Diseases Orthopedic Surgery residents; 48 consecutive residents assessed. Four orthopedic cases were developed. USPs presented themselves as patients in outpatient clinics. Residents were evaluated on communication skills (information gathering, relationship development, and education and counseling). USPs globally rated whether they would recommend the resident. Forty-eight USP encounters were completed over a 2-year period. Communication skills items were rated at 51% (±30) "well done." Education and counseling skills were rated as the lowest communication domain at 33% (±33). Residents were globally recommended based on communication skills in 63% of the encounters recommended in 70% of encounters based on both professionalism and medical competence. The USP program has been useful in assessing residents' clinical skills, interpersonal and communications skills, and professionalism. Use of USP in orthopedic surgery training programs can be an objective means for trainee assessment.

Hand Surgery Resources Exceed American Health Literacy.

The National Institutes of Health, American Medical Association, and US National Library of Medicine recommend that educational material for patients be written at a sixth-grade reading level. The purpose of this study is to assess the complexity of hand surgery information on academic plastic and orthopedic surgery websites. An online search was performed for all hand surgery patient education materials provided by institutions with plastic and orthopedic surgery training programs. Readability analyses were conducted using the Flesch-Kincaid Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Index, Gunning Fog Score, Automated Readability Index, and Coleman-Liau Index. A 2-tailed z test was used to compare means. Seventy-six institutions with both plastic and orthopedic surgery training programs were identified; 42 had educational material available online. The average readability for all hand-related information was at the 11.92 grade reading level. Information regarding de Quervain tenosynovitis had the highest grade level for all plastic surgery procedures (13.45). Hand arthritis had the highest grade level for all orthopedic surgery procedures (12.82). Ganglion cysts had the lowest grade level for both plastic and orthopedic surgery (10.15 and 11.01, respectively; P = .12). Carpal tunnel release was the most commonly described procedure overall. There were no differences in text complexity among geographic regions. Online patient resources for common hand ailments are too complex for the average patient to understand. Efforts should be made to provide materials at the recommended sixth-grade reading level to improve patient education and improve the physician-patient relationship.

Trauma surgery in Pacific Small Island Developing States (SIDS)

The small developing countries in the Pacific are grouped together as Small Island Development States (SIDS) because they face similar problems which they cannot cope with nationally. They are developing countries, so-called low and lower middle income countries (LMIC), are economically weak and the islands of the different nations are widely scattered. Approximately 80% of the 10 million inhabitants live in rural regions. Over 40% of patients in the surgical departments of hospitals are hospitalized for injuries, and this tendency is increasing. Fractures of the upper extremities are relatively more frequent in the Pacific than in the countries of the North. Long distances, lack of possibilities for treatment and lack of transport often cause complications, such as infected open fractures, pseudarthrosis and posttraumatic malformations. There are too few hospitals with sufficiently competent surgeons, anesthetists and obstetricians (SAO) and appropriate equipment. The PIOA was founded in Honiara, Solomon Islands, and offers surgeons of the Pacific SIDS acomprehensive, structured trauma and orthopedic surgery training in their own countries. It lasts 4 years and leads to an M‑Med (orthopaedic surgery) diploma and to aFellowship of the International College of Surgeons (FICS), which are both recognized by the participating hospitals. It is free for participants. The AOAF is an independent organization with the only aim to enhance trauma surgery capacity in LMICs. The AOAF supports the PIOA program together with the Wyss Medical Foundation. Currently, 18trainees from 8 Pacific SIDS are participating in the PIOA training program.

The Fourth Year of Medical School: Time for Reassessment: AOA Critical Issues.

Most U.S. medical schools follow the 4-year model, consisting of 2 preclinical years, core clinical experience, and a fourth year intended to permit students to increase clinical competency, to explore specialty areas, and to transition to residency. Although the design and delivery of Years 1 through 3 have evolved to meet new challenges and expectations, the structure of Year 4 remains largely unchanged. For most students considering a career in orthopaedics, Year 4 is a series of elective rotations in which educational objectives become secondary to interviewing for residency programs. Most accreditation bodies recognize the importance of attainment of competency over the duration of medical school as the goal of educating physicians, and thus, there is a growing interest in reexamining the traditional medical school curriculum with the goal of integrating the final phases of undergraduate education and the first phases of postgraduate education.A literature search was undertaken to identify publications on the duration of medical education. Pilot approaches to competency-based integration of undergraduate medical school and postgraduate training in orthopaedic surgery were reviewed.There have been few data suggesting that 4 years of medical education is superior to shorter-duration programs. Three approaches to competency-based integration of undergraduate medical school and postgraduate training are presented. Their goal is to use student and faculty time more effectively. Each approach offers the opportunity to lower the cost and to decrease the time required for Board Certification in Orthopaedic Surgery. Two approaches shorten the entire duration of medical school and graduate training by using various proportions of the fourth year to begin residency, and one approach expands the duration of orthopaedic training by starting in the fourth year of medical school and including training equivalent to a fellowship program into the residency experience.The effectiveness of such programs will form the basis for revisions to the current orthopaedic training paradigm, resulting in a more effective, efficient, and integrated orthopaedic training curriculum.

Can a Novel, Low-Cost Simulation Model be Used to Teach Anterior Cruciate Ligament Graft Preparation?

This study evaluated an anterior cruciate ligament (ACL) graft preparation simulation learning model for use by orthopaedic surgery trainees. A simulation model for ACL graft preparation was constructed using shoelace as graft material and a wooden graft preparation board that matched the dimensions of existing products. A 12-minute instructional video targeted at novice learners was created to accompany the simulation model. A prospective randomized controlled trial was conducted on orthopaedic surgery residents divided into 2 groups with equal distributions of postgraduate year (PGY) status. The intervention group learned ACL graft preparation via the Shoelace ACL Simulation Guide, whereas a control group viewed a standard instructional video. All participants then prepared an 8-strand ACL graft using allograft materials and were evaluated via a checklist of critical steps and a global assessment rating as provided by an expert blinded to group allocation. Participants' preintervention and postintervention self-assessment scores were also collected. Ten orthopaedic surgery residents from a single institution participated in the study, with even distributions across study groups of PGY-1, PGY-3, and PGY-4 residents. Preintervention self-assessments of knowledge and technical ability were similar between participant groups. The mean overall performance score was significantly greater in the shoelace simulation intervention group (22.6±1.5) than in the instructional video only control group (16.0±5.1) (P=0.043). Participants in the intervention group showed greater improvement in self-confidence in their technical ability than those in the control group (P=0.012). Groups demonstrated similar postintervention improvements in self-reported knowledge of ACL graft preparation (P=0.128). All participants who learned via the Shoelace ACL Simulation Guide strongly agreed that they would use the learning tool to prepare for ACL reconstruction surgery. A self-directed low-cost simulation model for soft tissue ACL graft preparation utilizing shoelaces resulted in improved performance metrics compared with standard video instruction. The teaching model may be incorporated easily and inexpensively into simulation curricula at other training programs. Level II-therapeutic study.

Incidence and characteristics of needlestick injuries among medical trainees at a community teaching hospital: A cross-sectional study.

This field study aimed to determine the incidence and distribution of needlestick injuries among medical trainees at a community teaching hospital in Toronto, Canada. The study was performed during the 2013-2015 academic years at Toronto East General Hospital (TEGH), a University of Toronto-affiliated community-teaching hospital during the 2013-2015 academic years. Eight-hundred and forty trainees, including medical students, residents, and post-graduate fellows, were identified and invited via email to participate in an anonymous online fluidsurveys.com survey of 16 qualitative and quantitative questions. Three-hundred and fifty trainees responded (42% response rate). Eighty-eight (25%) respondents reported experiencing at least one injury at TEGH. In total, our survey identified 195 total injuries. Surgical trainees were significantly more likely to incur injuries than non-surgical trainees (IRR = 3.03, 95% CI 1.80-5.10). Orthopaedic surgery trainees had the highest risk of a needlestick injury, being over 12 times more likely to be injured than emergency medicine trainees (IRR = 12.4, 95% CI 2.11-72.32). Only 28 of the 88 most recent needlestick injuries were reported to occupational health. Trainees reported a perception of insignificant risk, lack of resources and support for reporting, and injury stigmatization as reasons for not reporting needlestick injuries. Needlestick injuries were a common underreported risk to medical trainees at TEGH. Future research should investigate strategies to reduce injury and improve reporting among the high-risk and reporting-averse trainees.

Die Berufsverlaufszufriedenheit von Assistenzärzten und -ärztinnen nach vierjähriger Weiterbildung

ObjectiveTo evaluate German residents’ career satisfaction and its dependency on intrinsic and extrinsic factors after four years of postgraduate training. Gender, parental status, training conditions and specialty choice were of particular interest. MethodsPostal questionnaires were sent to medical graduates from seven different German faculties annually, starting in 2009. This paper presents cross-sectional data of domestic, working and training conditions four years after graduation. We used descriptive statistics and t-tests. In order to identify factors with an impact on career satisfaction, multiple regression analyses were calculated. ResultsMale residents who have children tended to be more satisfied with their career than residents without children. For female residents, however, having children was associated with lower career satisfaction. Those who chose training in general surgery or orthopedic surgery were less satisfied with their career progress. Residents with prolonged specialty training showed lower career satisfaction. Junior doctors who rated the quality of their residency training higher were more satisfied with their career. Those who perceived their job as particularly demanding were less satisfied. Concerning intrinsic factors, occupational self-efficacy and overall satisfaction with life were significantly associated with career satisfaction. ConclusionResidents in general are quite satisfied with their career after four years of training. Opportunities to work part-time during residency as well as structured training programs should be implemented in order to overcome parenthood as a career obstacle for female residents. The quality of specialty training is particularly important for career satisfaction and has to be ensured across specialties.

Retention of Skills After Simulation-based Training in Orthopaedic Surgery.

Simulation-based surgical skills training has become essential in orthopaedic practice because of concerns about patient safety and an increase in technically challenging procedures. Surgical skills training in specifically designed simulation laboratories allows practice of procedures in a risk-free environment before they are performed in the operating room. The transferability of acquired skills to performance with patients is the most effective measure of the predictive validity of simulation-based training. Retention of the skills transferred to clinical situations is also critical. However, evidence of simulation-based skill retention in the orthopaedic literature is limited, and concerns about sustainability exist. Solutions for skill decay include repeated practice of the tasks learned on simulators and reinforcement of areas that are sensitive to decline. Further research is required to determine the retention rates of surgical skills acquired in simulation-based training as well as the success of proposed solutions for skill decay.

Simulation Training Improves Surgical Proficiency and Safety During Diagnostic Shoulder Arthroscopy Performed by Residents.

Although virtual reality simulators have established construct validity, no studies have proven transfer of skills from a simulator to improved in vivo surgical skill. The current authors hypothesized that simulation training would improve residents' basic arthroscopic performance and safety. Twenty-two orthopedic surgery trainees were randomized into simulation or standard practice groups. At baseline testing, all of the participants performed simulator-based testing and a supervised, in vivo diagnostic shoulder arthroscopy with video recording. The simulation group subsequently received 1 hour of total instruction during a 3-month period, and the standard practice group received no simulator training. After intervention, both groups were reevaluated with simulator testing and a second recorded diagnostic shoulder arthroscopy. Two blinded, independent experts evaluated arthroscopic performance using the anatomic checklist, Arthroscopic Surgery Skill Evaluation Tool (ASSET) score, and total elapsed time. All outcome measures were compared within and between groups. After intervention, mean time required by the simulation group to complete the simulator task (30.64 seconds) was 8±1.2 seconds faster than the time required by the control group (38.64 seconds; P=.001). Probe distance (51.65 mm) was improved by 41.2±6.08 mm compared with the control (92.83 mm; P=.001). When comparing ASSET safety scores, the simulation group was competent (3.29) and significantly better than the control group (3.00; P=.005) during final arthroscopic testing. This study establishes transfer validity for an arthroscopic shoulder simulator model. Simulator training for residents in training can decrease surgical times, improve basic surgical skills, and confer greater patient safety during shoulder arthroscopy. [Orthopedics. 2016; 39(3):e479-e485.].