Orthopaedic Residents Research Articles

Implementation of High-Value Care for Physical Therapy Residents Through Systems-Based Practice Curriculum Development: Case Report.

Systems-based practice is a core competency for physical therapy residents, best acquired through experiential learning. Peer health professions are further along than physical therapy in implementing curricula that support systems-based practice. Clinical and practice data in residency programs could provide for education in high-value care (HVC) as a foundation for systems-based practice. Our purpose was to develop and assess a HVC curriculum incorporating reflective practice to help residents achieve competency in systems-based practice. The Logic Model, which evaluates key components needed for success and sustainability, was used to identify resources for a curriculum in HVC. Two orthopedic physical therapy residents and 5 faculty mentors participated in didactic and mentoring sessions. A practice dashboard for each clinician was developed to facilitate resident-mentor discussions. Focus group input was used to refine the curriculum. The validated Systems Thinking Scale, the Quality Improvement Knowledge Application Tool Rubric, and the American Physical Therapy Association Residency Core Competency Score were used to assess residents' progress and to make comparisons to prior years' residents. The residents demonstrated increases in systems thinking and quality-improvement knowledge and improvements in clinical outcomes and practice efficiencies. Three themes emerged from semistructured interviews: challenges to HVC, current approach in HVC, and future-oriented thinking in HVC in practice. This study demonstrates that HVC activities and a personalized clinical dashboard in a physical therapy residency program can facilitate experiential learning of systems-based practice, a core competency for value-centered, inclusive practice.

A mixed methods analysis of barriers to and facilitators of scholarly education in orthopaedic surgery residency

A mixed methods analysis of barriers to and facilitators of scholarly education in orthopaedic surgery residency

Preference signaling in orthopaedic surgery: applicant perspectives and opinions.

Orthopaedic surgery has become increasingly competitive over the years, with the COVID-19 pandemic creating additional challenges for applicants and programs. To promote an equitable match experience, the American Orthopaedic Association (AOA) introduced a formal preference signaling (PS) system into the 2022-2023 application cycle. PS allows applicants to indicate their heightened interest in specific programs, which improves the likelihood of receiving an interview and ultimately matching at their desired residency program. The objective of this anonymous survey is to assess applicants' opinions and perspectives toward PS in orthopaedic surgery prior to the 2022-2023 match results. Additionally, we sought to evaluate the signaling strategies being utilized by applicants. An anonymous 22-question survey was distributed to applicants of an orthopaedic surgery residency program (34.2 % response rate). Responses were collected after the application submission deadline but before the match lists and results were available. This survey included questions germane to demographics, signal utilization, signaling reasons and strategies, and opinions toward PS.Descriptive statistics were calculated utilizing R (version 4.2.1) and RStudio. Most respondents (96.1 %) participated in PS, and 96.7 % utilized all 30 signals. Signaling encouraged 24.2 % ofapplicants to apply to fewer programs. In accordance withguidelines, 83.2 % of respondents signaled each away rotation program; however, only 53 % signaled their home program. Applicants commonly signaled 1-10 "reach" and "safety" programs each. Proximity to Family and Perceived Operative Experience were the most important reasons forsignaling, whereas Program Prestige was the least. A program's social presence and virtual interview option did not influence many applicants' decisions for signaling. Most applicants believe that the COVID-19 pandemic and pass/fail licensure examinations influenced PS adoption. Sixty-seven of 149 respondents (45 %) claimed that applicants and programs benefit equally from PS, while 41 % believe programs benefit more. Nearly half (40.94 %) knew very littleor nothing about PS. During the inaugural introduction of PS in orthopaedic surgery, nearly every applicant utilized all 30 signals, prioritizing factors like family proximity and perceived operative experience over program prestige. Thisshift reflects the importance of geographic location andpresumed training quality. Despite unfamiliarity toward PS, personalized signaling strategies were implemented, accompanied by a slight decrease in application volumes. The30 allotted signals in orthopaedic surgery may serve as aninformal application cap due to the necessity of signaling aprogram for an interview invite. However, improved educational efforts are needed to enhance the understanding and maximize the benefits of PS for both applicants and programs.

A Comparison of Demographic Diversity Between Orthopaedic Surgery Residents and ACGME Foot and Ankle Fellows From 2007 to 2022.

Academic medicine emphasizes the need to recruit a diverse workforce in graduate medical education. Orthopaedic surgery residency has demonstrated efforts to model program compositions with evolving US demographics. However, it remains unclear whether orthopaedic fellowships, particularly foot and ankle, also reflect these efforts. Using the publicly available Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book, a census of the gender and racial/ethnic identities of orthopaedic foot and ankle fellows, as well as active orthopaedic surgery residents, were compiled from 2007 to 2022. Linear trend analysis was conducted to evaluate the trends of orthopaedic residents and foot and ankle fellows, with a Pearson correlation for comparison. Prior analysis demonstrated no significant change in sex and ethnic diversity of fellows from 2006 to 2015. The majority of foot and ankle fellows were White (31%-69%) and male (63%-88%). Linear analysis demonstrated growing diversity in female and non-White active orthopaedic surgery residents. Similarly, there was an increasing number of female foot and ankle fellows (0%-38%) reflective of the trend in orthopaedic residency (12%-20%); however, there was no significant change among racial/ethnic identities. Pearson correlation analysis between the trend of orthopaedic residency residents and foot and ankle fellows suggests moderate correlation among female, Asian, and "Unknown" racial/ethnic categories. The proportion of foot and ankle female fellows in ACGME-accredited fellowships has matched or exceeded the percentage of female orthopaedic residents. Despite increased diversity of orthopaedic surgery residents over the past 2 decades, ACGME-accredited foot and ankle fellowships do not yet reflect similar trends among racial/ethnic minorities. Level III, retrospective cohort study.

A Surgical Skills Rotation for Mid-Level Residents.

The University of Iowa orthopaedic residency previously designed a month-long surgical skill rotation for postgraduate year (PGY)-1 residents. This successful initiative has become a model of interest for other teaching institutions. In addition to the intern year, an important phase in residency occurs during the transition from PGY2 to PGY3, when residents assume greater responsibility and autonomy in leading surgical procedures. To directly address this transition and assess residents' readiness, our residency program established a week-long PGY2 surgical skills rotation. This rotation serves as a training checkpoint and focuses on both training and evaluation of level-appropriate skills in joint arthroplasty, trauma, arthroscopy, and wire navigation. The primary objective of the PGY2 surgical skills rotation is to enhance orthopaedic residents' operative skills and experience by providing increased exposure and practice of requisite technical skills. Similar to the Orthopedic In-Training Examinations that assess residents' knowledge, this week-long program, aimed at assessing residents' proficiency in fundamental orthopaedic technical skills, occurs before their PGY3 year. Faculty-led training and assessment sessions in each area offer residents many opportunities for dedicated practice and improvement. Transferring these acquired skills from the laboratory to the operating room is essential for a training program. To confirm improvement, the final day of the surgical skills rotation was exclusively dedicated to structured performance evaluations, with a specific emphasis on establishing proficiency benchmarks. We herein describe the University of Iowa's PGY2 surgical skills rotation, providing insights into its development, implementation, and outcomes. By sharing our experience, we offer a framework for other academic departments seeking to optimize surgical skills education and ensure the successful transition of mid-level residents.

Location, location, location: How does residency program leadership vary according to geographic region?

Background: Faculty relationships are key to resident education. Residency applicants may find it more appealing to choose programs where the faculty have a similar background. With the addition of geographic preferences to the application process, applicants may find it beneficial to know general faculty makeup in each region. The purpose of this study was to evaluate the relationship of geographic location and orthopaedic residency leadership characteristics. Methods: The Accreditation Council for Graduate Medical Education (ACGME) and Doximity websites were queried in September 2022 to identify United States orthopaedic residency programs for the 2022-2023 cycle. Program attributes were categorized by region. Program leaders evaluated in this study consisted of Chairs, Vice Chairs, Program Directors (PDs), and Assistant PDs. Results: A total of 192 programs with 425 leaders were included. Leaders were mostly PDs (42.6%, n=181), men (88.7%, n=377), MDs (90.6%, n=385), and trained in the US (96.9%, n=412). The Northeast had the most programs (n=59, 30.7%) and leadership positions (n=136, 32.0%). The West had higher proportions of internationally-trained and women leaders (8.2%, P=0.046 and 18.0%, P=0.072), although the latter only trended towards significance. The South contained the lowest prevalence of internationally-trained leaders (0.8%, P=0.046). The Midwest exhibited the largest amount of DO leadership (16.0%, P=0.022). The Northeast had more surgeons subspecialized in hand/upper extremity (19.9% vs. 10.0%, P=0.033) yet relatively fewer in oncology (2.9% vs. 10.7%, P=0.041). Conclusions: Program attributes varied by region. This information is valuable to applicants and leaders as the field strives to strengthen and diversify its leadership.

Revisiting Differences in Fourth-Year Orthopaedic Away Rotation Opportunities and Fees Among Allopathic and Osteopathic Medical Students.

Fourth-year away rotations are an important modifiable variable proven to increase students' opportunities to match into orthopaedic surgery. The purpose of this study was to determine differences in away rotation eligibility requirements and cost of rotation between allopathic and osteopathic students during the 2023 application cycle. Eligibility requirements and fees were then compared with the 2021 application cycle. A cross-sectional study was performed during the 2023 application cycle of all nonmilitary, Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs (n = 194). Each program's website, affiliated school of medicine's website, visiting student application service portal, and Residency Explorer tool were searched for eligibility criteria, associated rotation fees, and other rotation requirements. Two-sample Z tests for proportions were utilized to compare differences in programs with differing requirements for students based on academic degree type. Data were compared statistically with previously reported data from the 2021 application cycle. In 2023, there were more programs that restricted osteopathic medical students from away rotations than programs that restricted allopathic medical students (12/194, 6.2% vs. 0/194, 0.0%; p < 0.001). All 12 programs were formerly ACGME-accredited before the integration into a single accreditation system. There was a decrease in the number of programs restricting osteopathic medical students from away rotations compared with the 2021 application cycle (18/194, 9.3% vs. 12/194, 6.2%; p = 0.254). Fees associated with away rotations ranged from $25 to $4,000 for both allopathic and osteopathic students. The number of programs that charged osteopathic medical students higher rotation fees than programs that charged allopathic students when compared with the 2021 application cycles decreased (1/194, 0.5% vs. 5/194, 2.6%; p = 0.049). While some programs continue to have away rotation eligibility requirements that prohibit osteopathic medical students from rotating, only one residency program currently charges osteopathic medical students a higher fee to rotate than allopathic medical students.

Reliability of a Modified Watson-Jones Classification for Tibial Tubercle Fractures in Children.

The first case report describing a pediatric fracture of the tibial tubercle was published in 1852 in the Medical Times and Gazette, a Journal of Medical Science, literature, criticism, and news. A century later, in 1955, Sir Watson-Jones introduced the first classification system for this fracture. Despite the existence of several classification systems for pediatric tibial tubercle fractures in the medical literature, a crucial aspect of their validation-reliability and reproducibility-has not yet been systematically evaluated. In this study, a modified Watson-Jones (mWJ) classification system of tibial tubercle fractures in children was assessed for intraobserver and interobserver variability. Using the mWJ classification, 3 board-certified pediatric orthopaedic surgeons and 3 orthopaedic surgery residents, classified thirty tibial tubercle fractures based on anteroposterior and lateral radiographs on 2 separate occasions in a 2-week duration. Further comparison was made to evaluate the impact of advanced imaging, specifically computed tomography or magnetic resonance imaging, on diagnostic reliability and reproducibility. The study found substantial intraobserver reliability of the mWJ classification based on radiographs alone, with a Cohen weighted kappa (κ w ) coefficient of 0.733. When advanced imaging was utilized, the reliability of the classification improved to κ w = 0.783. Similarly, interobserver reliability demonstrated substantial consistency among observers when using radiographs alone (κ w = 0.69) and improved agreement with advanced imaging (κ w = 0.75). Notably, there was no significant difference in reliability scores between senior-level attendings and residents when analyzed as separate groups. Fracture classification systems are clinically relevant tools that help organize and transfer knowledge efficiently, provide treatment guidance, propose prognostic expectations, and improve communication in academic literature. The present study demonstrated substantial reproducibility of an mWJ fracture classification system both between and within individual surgeon raters. Level III-diagnostic.

Trends in Gender Diversity Among Orthopaedic Applicants, Residents, Physician Associates, and Faculty

Trends in Gender Diversity Among Orthopaedic Applicants, Residents, Physician Associates, and Faculty

Orphan Applicants in Orthopedic Surgery: Where Do Allopathic Applicants Without an Affiliated Residency Program Match?

Background Orthopedic surgery is one of the most competitive specialties to match into a residency. With a plethora of qualified applicants and the subjective nature of matching into any residency program, it can be difficult to accurately assess the chances of successfully matching into orthopedic surgery and the types of programs an applicant will match into. The purpose of this study is to compare the types of programs that students from medical schools with and without home programs match. Methods This was a five-year retrospective study (2019 to 2023) analyzing 155 United States Doctor of Medicine (M.D.) programs and their orthopedic residency-matched students. Of the 155 programs, 40 were excluded from the study due to the lack of obtainable data. For each medical school, we analyzed several variables: the presence of a home program, the total number of orthopedic residency matches, residency program matches, and residency program affiliation (academic, community, university-affiliated community-based, military). Results Of the 2066 total matched applicants from institutions with home programs, 1508 (73%) matched into academic centers, 315 (15.3%) into university-affiliated community programs, 172 (8.3%) into community programs, and 71 (3.4%) into military programs. In contrast, of the 219 total matched applicants from institutions without home programs (orphan applicants), 144 (67.8%) matched into academic programs, 36 (16.4%) into university-affiliated community programs, 28 (12.8%) into community programs, and 11 (5%) into military programs. Conclusion A greater proportion of students from institutions with home programs matched into academic centers compared to orphan applicants (73% vs. 65.8%). A greater proportion of orphan applicants matched into community programs (12.8% vs. 8.3%).

Analysis of the diversity pipeline for the orthopedic trauma surgeon workforce in the United States

IntroductionThere is a lack of research on the state of racial, ethnic, and gender diversity in the emerging orthopedic trauma workforce. The purpose of this study was to analyze the training pathway for diverse candidates in orthopedic trauma as it relates to race, ethnicity, and sex. MethodsSelf-reported demographic data were compared among allopathic medical students, orthopedic surgery residents, orthopedic trauma fellows, and the general population in the United States (2013–2022). Race categories consisted of White, Asian, Black, and Native American/Alaskan Native (NA/AN), and Native Hawaiian/Pacific Islander (NH/PI). Ethnicity categories were Hispanic/Latino or non-Hispanic/Latino. Sex categories were male and female. Representation was calculated at each stage of accredited training. Participation-to-prevalence ratios (PPRs) quantified the equitable representation of demographic groups in the emerging orthopedic trauma workforce relative to the US population. PPR thresholds were used to classify representation as overrepresented (PPR > 1.2), equitable (PPR = 0.8–1.2), and underrepresented (PPR < 0.8). ResultsRelative to medical school and orthopedic surgery residency, fewer female (48.5 % vs 16.7 % vs 18.7 %, P < 0.001), Hispanic (6.1 % vs 4.5 % vs 2.6 %, P < 0.001), Black (6.9 % vs 5.0 % vs 3.1 %, P < 0.001), and Asian (24.0 % vs 14.3 % vs 12.2 %, P < 0.001) trainees existed in orthopedic trauma fellowship training. In contrast, more male (51.5 % vs 83.3 % vs 81.3 %, P < 0.001) and White (62.8 % vs 79.1 % vs 84.0 %, P < 0.001) trainees existed in orthopedic trauma fellowship relative to earlier training stages. There were zero NA/AN or NH/PI trainees in orthopedic trauma (PPR = 0). Relative to the US population, Hispanic (PPR = 0.14), Black (PPR = 0.25), and female (PPR = 0.37) trainees were underrepresented in orthopedic trauma. In contrast, Asian (PPR = 2.04), male (PPR = 1.64), and White (PPR = 1.36) trainees were overrepresented in orthopedic trauma. ConclusionWomen, racial, and ethnic minorities are underrepresented in the emerging orthopedic trauma workforce relative to the US population, and earlier stages of training. Targeted recruitment and guided mentorship of these groups may lead to greater interest, engagement, and diversity in orthopedic trauma.

CORR Insights®: Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

CORR Insights®: Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

CORR Insights®: How Did Black and Hispanic Orthopaedic Applicants and Residents Compare to General Surgery Between 2015 and 2022?

CORR Insights®: How Did Black and Hispanic Orthopaedic Applicants and Residents Compare to General Surgery Between 2015 and 2022?

Effect of clinician's experience and expertise on the inter- and intra-observer reliability of the computed tomography-based classification systems in posterior malleolus fractures.

Three computed tomography (CT)-based classifications, including Haraguchi, Bartoníček-Rammelt, and Mason-Molloy systems, have been developed to better determine the characteristics of posterior malleolus fractures (PMFs). The aims of this study were (1) to determine the intra- and inter-observer reliability of the computed tomography-based classification systems and (2) to investigate the clinical experience and expertise on their reliabilities. Sixty-seven preoperative ankle CT scans of 67 adult patients with "ankle fracture with the involvement of the posterior malleolus"'' were retrospectively identified. CT images were assessed by 10 observers with different levels of clinical experience from 2 different specialties, including orthopedics and radiology. The observers were asked to classify PMFs according to 3 CT-based classifications on 2 separate occasions with a 4-week interval. Cohen's κ values were measured for 2 raters and Fleiss' κ values were measured for 3 raters and more. Overall, each classification had moderate to very good intraobserver reliability (κ=0.41 to 0.95, P < .01) as well as moderate interobserver reliability for each of the 2 separate assessments (κ=0.41 to 0.60, P < .01 for the first occasion; κ=0.44 to 0.59, P < .01 for the second occasion). Interobserver agreement among the foot and ankle surgeons regarding the Haraguchi and Bartoníček classifications was substantial for both assessment periods, whereas there was a moderate agreement for the Mason classification. Orthopedic residents showed moderate interobserver agreement in each period for both Bartoníček and Mason classifications. Radiology experts illustrated slight and fair agreements in the 2 assessments for Mason classification, moderate agreement in both assessments for Haraguchi classification, and substantial to moderate agreement in the first and second assessments for Bartoníček classification, respectively. Computed tomography-based classification system for PMFs demonstrated moderate interobserver reliability as well as moderate to very good intraobserver reliability. Moreover, foot and ankle specialists exhibit enhanced K values for both inter and intraobserver reliability for each classification system, consistency seems to increase as the interest in the field condenses.

Analysis of the reliability of KEOPS version 2 for the measurement of coronal and sagittal parameters in spinal deformity.

The purpose of the study is to evaluate the updated version of this software in patients with various spinal deformity. Sixty patients were included in this study and were divided into three categories: 20 patients with AIS, 20 patients with ASD, and 20 patients having undergone corrective surgery for spinal deformity. The measurements were performed by two senior and two junior orthopedic surgery residents, and were done at two points in time separated by a 3-week interval with the cases being randomized every time to reduce the risk of memory bias. Measured parameters included coronal, sagittal, global alignment parameters, andpelvic parameters. When assessing the inter- and intra-observer reliability across all the groups of patients, none of the coefficients was smaller than 0.8 with a very high level of agreement. The standard error ranged from 0.7° to 1.5° demonstrating a high level of accuracy. Fairly similar results were seen when the groups were divided into the three categories except for the post-operative groups where a strong and not perfect level of agreement was reported. This is the first study to assess the reproducibility of the new version of KEOPS, showing a very high agreement in all measurements. In the post-operative group, although it showed a strong agreement, the lower performance can be explained by the presence of surgical material making it harder to identify the anatomical landmarks accurately. Nevertheless, we can recommend the usage of this software in a clinical setting.

Success of Resident Research Grants in Orthopaedic Trauma From 2000 to 2022: A Retrospective Review.

The objective of this study was to determine the publication rate for orthopaedic trauma resident research projects that receive grant funding and the long-term academic involvement of the grant recipients. Retrospective. Publically available records for resident research grant recipients. Resident research grants on orthopaedic trauma topics from Orthopaedic Trauma Association (OTA), AO North America (AONA), and Orthopaedic Research and Education Foundation from 2000 to 2022. Subsequent related publications, grant size, time to publication, sustained academic involvement of the residents as measured by academic position, total number of publications, and h-index. Three hundred ninety-seven orthopaedic trauma grants (OTA 117, AONA 225, and OREF 55) were identified. A total of 38% (151) of grants resulted in a publication with no significant difference between agencies (P = 0.94). The average amount awarded was $9,843, with no correlation to publication (P = 0.63). The mean time to publication was 3.57 ± 2.33 years. The time to publication for AONA was significantly longer than for OTA (4.14 vs. 2.83 years, P = 0.004). There was no difference in total publications, h-index, or NIH grants between grant recipients from different agencies. More OTA grant recipients held an academic position compared with AONA grant recipients (63% vs. 43%, P = 0.003). Grant awardees with initial publication success were 1.7 times as likely to have a future academic appointment (P = 0.014) and had 1.9 times the number of publications than those without (P = 0.001). Awardees with an h-index in the top quartile were significantly more likely to have published than those with an h-index in the bottom quartile (P = 0.007). Fewer than half of orthopaedic trauma-related resident research grants resulted in a publication with comparable rates across agencies. Grant size did not predict publication success. Publication success was a positive predictor of continued academic involvement. Most publications occurred within 5 years, suggesting that these grants may be most helpful in career development if awarded during the first 1-2 years of a 5-year orthopaedic residency program.

Orthopaedic Surgery Residency Program Websites: Assessing Information Gaps and Opportunities for Attracting Applicants.

The quality and volume of information on orthopaedic surgery residency program websites are helpful for informed decision making of prospective applicants. The purpose of this study was to evaluate the content on orthopaedic surgery residency program websites and identify areas for improvement. In November 2023, 203 orthopaedic surgery residency programs were reviewed using the Association of American Medical Colleges Residency Explorer tool. Fourteen nonfunctional websites were excluded, leaving n = 189. Websites were assessed for 11 variables: resources for assisting resident research (eg, biomechanics laboratory, research assistant, and advisors), residents' past institutional affiliations, current resident profiles (including hometown and interests), alumni data, fellowship matches, American Board of Orthopedic Surgery I/II pass rates, Alpha Omega Alpha Society affiliation, target United States Medical Licensing Examination/ Comprehensive Osteopathic Medical Learning Exam Step 2 scores, educational activities (journal club, grand rounds, didactics), evaluation methods, and mentorship. Website variables differed markedly among identified program types, which included community programs, university programs (UPs), and affiliated programs (APs). Disparities were noted in the disclosure of residents' previous institutions ( P = 0.001), the availability of alumni names ( P = 0.001), research resources ( P = 0.001), academic activities ( P = 0.007), assigned mentorship programs ( P = 0.006), and fellowship match information ( P = 0.027). Notably, community programs shared statistically significantly less information in these areas compared with UPs and APs ( P = 0.001). While there was a proportionate sharing of information between UPs and APs, UPs exhibited a slightly higher overall percentage of websites sharing more detailed information. The quality and comprehensiveness of information on orthopaedic surgery residency program websites vary markedly. Most of the orthopaedic surgery residency programs provided information on residents' past institutions and academic activities. However, very few provided information on designated mentorship programs or objective measures such as target Step 2 examination scores and ABOS pass rates. Improving the quality of information available on program websites will enhance transparency and consistency, enabling prospective applicants to make more informed decisions about where to apply and interview.

Surgeon's Experience and Accuracy of Preoperative Digital Templating in Primary Total Hip Arthroplasty.

Preoperative planning has become essential in performance of total hip arthroplasty (THA). However, data regarding the effect of the planner's experience on the accuracy of digital preoperative planning is limited. The objective of this study was to assess the accuracy of digital templating in THA based on the surgeon's experience. A retrospective study was conducted. An analysis of 98 anteroposterior pelvic radiographs, which were individually templated by four surgeons (two hip surgeons and two orthopaedic residents) using TraumaCad® digital planning, was performed. A comparison of preoperatively planned sizes with implanted sizes was performed to evaluate the accuracy of predicting component size. The results of preoperative planning performed by hip surgeons and orthopaedic residents were compared for testing of the planner's experience. Femoral stem was precisely predicted in 32.4% of cases, acetabular component in 40.3%, and femoral offset in 76.7%. Prediction of cup size showed greater accuracy than femoral size among all observers. No differences in any variable were observed among the four groups (acetabular cup P=0.07, femoral stem P=0.82, femoral offset P=0.06). All measurements showed good reliability (intraclass correlation coefficient [ICC] acetabular cup: 0.76, ICC femoral stem: 0.79). The results of this study might suggest that even though a surgeon's experience supports improved precision during the planning stage, it should not be restricted only to surgeons with a high level of experience. We consider preoperative planning an essential part of the surgery, which should be included in training for orthopaedics residents.

The influence of virtual reality simulation on surgical residents’ heart rate during an assessment of arthroscopic technical skills: A prospective, paired observational study

HypothesisTo demonstrate that a virtual reality (VR) simulation training program reduces heart rate variability during an assessment of surgical trainees’ technical skills in arthroscopy. Study designProspective observational matched study. Materials & methodsThirty-six orthopaedic surgery residents, new to arthroscopy, received standard training in arthroscopic knee surgery, supplemented by additional monthly training for 6months on a VR simulator for 16 of them. At inclusion, the 2 groups (VR and NON-VR) answered a questionnaire and performed a meniscectomy on a VR simulator. After 6months of training, two independent trainers blinded to the inclusion arms evaluated the technical skills of the two groups during meniscectomies on a model and on an anatomical subject. Heart rate variability (HRV) was measured using a wireless heart rate monitor during baseline, VR training, and assessment. ResultsAfter removing incomplete data, the analysis focused on 10 VR residents matched at inclusion with 10 NON-VR residents. The VR group had a significantly lower heart rate at the final assessment (p=0.02) and lower overall HRV (p=0.05). The low/high frequency ratio (LF/HF) was not significantly different between the groups (1.84 vs 2.05, p=0.66) but the before-after training comparison showed a greater decrease in this ratio in the VR group compared to the NON-VR group −0.76 (−41%) vs −0.08 (−4%). ConclusionThis study demonstrates a significant difference in heart rate variability between trained residents versus untrained residents during the final assessment of their technical skills at 6months. It appears that improving stress management should be an integral part of training programs in arthroscopic surgery. Clinical InterestVR simulators in arthroscopy could improve non-technical skills such as heart rate variability, from the perspective of accountability. Level of evidenceIII.

Evaluation of orthopaedic residents from SOCLE phase to osteosynthesis simulation: feedback from the AO course.

In 2019, the French College of Orthopaedic and Traumatology (CFCOT) made the AOTrauma course entitled "Basic Principles of Fracture Treatment" mandatory for all orthopaedic residents during the first year of their educational program i.e. during the SOCLE phase (common base phase). The objective of the evaluation was to determine which factors influenced the results of the practical work, according to the characteristics of the students and their experiences in laparoscopy or in arthroscopy in the operating theatre or on the simulator for arthroscopy. In 2019 a total of 121 residents were included, corresponding to the full promotion. They filled out a preliminary questionnaire giving information on their general characteristics. Eight different workshops were evaluated. The grading of skills was as follows: "A" for "acquired", "B" for "in progress" and "C" for "not acquired". The data was collected on a computerized spreadsheet. The statistical analysis used the Welch test, the Chi2 test and the Fisher test. The average "A" percentage across all workshops was 87.8%. Factors predictive of a good result were experience in laparoscopy as the main operator (p = 0.014) and male sex (p = 0.014). We observed that the residents who had not performed arthroscopy in clinical practice had done more training on simulators than the others (p = 0.044). Residents who had performed at least one arthroscopy as a main operator were predominantly female (p < 0.001). The interest of this study lies in the novelty of the analysis of the results of a whole promotion of residents in the SOCLE phase in osteosynthesis simulation. This novel evaluation deserves to be repeated by refining the evaluation tools before and during the course. It allowed us to know the weak points of the students during the simulated learning.