Background:Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency.Purpose:To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows.Study Design:Case series; Level of evidence, 4.Methods:A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine–accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions.Results:Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement ( P < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement ( P < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship ( P = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship ( P < .001).Conclusion:This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.

中文翻译：

---

骨科运动医学奖学金手术技能评估的制定和执行


背景：骨科手术实习生的评估传统上基于教师的主观评价。最近对基于价值的医疗保健的推动非常重视改善患者的治疗结果。因此，对骨科学员的手术培训评估正在不断发展，包括更客观的能力评估措施。目的：开发并随后证明针对骨科运动医学研究员的新型手术技能评估的有效性。研究设计：案例系列；证据级别，4。方法：由 14 名经过专科培训的骨科运动医学外科医生组成的团队使用改进的德尔菲法制定了前十字韧带重建 (ACLR) 和肩袖修复 (RCR) 的客观评分标准。评分标准是根据 10 个手术步骤设计的，分级范围（1-5）基于核心能力，最高总分为 50 分。来自不同地区的运动医学认可的研究金计划的 14 名骨科研究员受邀完成了两项研究：在奖学金年开始和结束时，ACLR 和 RCR 在外科技能实验室中。两次会议的个人手术步骤、整体表现和总手术时间均由一名运动医学外科医生进行评估。结果：14 名研究员中的 13 名完成了奖学金前和奖学金后评估。对于 ACLR 程序，奖学金前的平均总结分数为 25.4（SD，4.4），奖学金后的平均总结分数为 38.6（SD，4.1），这是统计上显着的改善（P < .001）。对于 RCR 程序，奖学金前的平均总结分数为 26.6（SD，5.4），奖学金后的平均总结分数为 38.8（SD，4.3），这也是统计上显着的改善（P<.001）。完成 ACLR 手术的平均时间在研究前为 82.3 分钟（SD，4.3 分钟），在研究后改善为 69.7 分钟（SD，11.6 分钟）（P = .002）。完成 RCR 手术的平均时间在研究前为 85.5 分钟（SD，5.0 分钟），在研究后改善为 76.4 分钟（SD，7.0 分钟）( P < .001)。结论：该手术技能计划代表了美国第一个用于评估 2 种关节镜运动医学手术的标准化且可重复的仪器。骨科运动医学研究员在其奖学金年度中在 ACLR 和 RCR 方面总体上取得了显着进步。所描述的程序有潜力作为培训工具和正式的骨科运动医学研究员评估。