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As residency training programmes around the globe move towards competency-based medical education (CBME), there is a need to review current teaching and assessment practices as they relate to education in orthopaedic trauma. Assessment is the cornerstone of CBME, as it not only helps to determine when a trainee is fit to practice independently, but it also provides feedback on performance and guides the development of competence. Although a standardised core knowledge base for trauma care has been developed by the leading national accreditation bodies and international agencies that teach and perform research in orthopaedic trauma, educators have not yet established optimal methods for assessing trainees' performance in managing orthopaedic trauma patients. This review describes the existing knowledge from the literature on assessment in orthopaedic trauma and highlights initiatives that have recently been undertaken towards CBME in the United Kingdom, Canada and the United States. In order to support a CBME approach, programmes need to improve the frequency and quality of assessments and improve on current formative and summative feedback techniques in order to enhance resident education in orthopaedic trauma. Cite this article: Bone Joint J 2016;98-B:1320-5., (©2016 The British Editorial Society of Bone & Joint Surgery.)

Valid and reliable techniques for assessing performance are essential to surgical education, especially with the emergence of competency-based frameworks. Despite this, there is a paucity of adequate tools for the evaluation of skills required during joint replacement surgery. In this scoping review, we examine current methods for assessing surgeons' competency in joint replacement procedures in both simulated and clinical environments. The ability of many of the tools currently in use to make valid, reliable and comprehensive assessments of performance is unclear. Furthermore, many simulation-based assessments have been criticised for a lack of transferability to the clinical setting. It is imperative that more effective methods of assessment are developed and implemented in order to improve our ability to evaluate the performance of skills relating to total joint replacement. This will enable educators to provide formative feedback to learners throughout the training process to ensure that they have attained core competencies upon completion of their training. This should help ensure positive patient outcomes as the surgical trainees enter independent practice.

Background: Previous studies have presented compelling data that a 1-month "boot-camp"-style course can be a highly effective mechanism for teaching and developing targeted technical skills. In the current study, we examine whether performance of these targeted skills is improved when residents are trained using directed, student-led (SL) learning methods compared with traditional instructor-led (IL) learning methods., Methods: Twelve first-year orthopedic residents began their training with a 1-month, intensive skills course. Six residents were taught basic surgical skills using a format that focused on deliberate, SL exploration and practice of the skills under instructor supervision (SL group). The remaining residents were taught the same surgical skills using more traditional IL methods that included complete demonstration of the surgical task by an orthopedic surgeon, followed by an extended period of instruction (IL group). Performance on 4 targeted technical skills (sawing, bone drilling, suturing, and plaster splint application) was tested using an objective, structured assessment of technical skills examination for the 2 groups at the beginning and the end of the skills course., Results: Before the start of the skills course, there were no differences in performance scores between the 2 groups. On completion of the skills course, mean global rating scores for the 4 surgical skills tasks were greater for the SL group compared with the IL group: SL, 3.95 ± 0.1; IL, 3.42 ± 0.1; F(1,10) = 7.66 P < .02. A similar pattern of results was revealed by the checklists scores, with the SL group outperforming the IL group: SL, 94.9 ± 2.1; IL, 86.4 ± 2.1; F(1,10) = 8.512; P < .02., Conclusion: Previous work has demonstrated the effectiveness of teaching basic surgical skills through an intensive course at the onset of residency. The present study shows that allowing surgical trainees to take a directed, student-regulated approach to learning basic surgical skills can further improve performance of these skills., (Copyright © 2013. Published by Mosby, Inc.)

Background: We examined retention rates for basic surgical skills taught through a 1-month intensive laboratory boot camp-style course at the onset of residency., Methods: We present data from 3 groups, each composed of 6 residents. The first group consisted of residents from a new competency-based curriculum (CBC). They started residency training with the Toronto Orthopaedic Boot Camp course. The other 2 groups were junior (JR) and senior (SR) residents from a traditional program whose residency training included no such course. Performance on targeted technical skills was tested using an objective structured assessment of technical skills examination 7 months after the onset of training for the CBC and JR groups and at least 43 months after the onset of training for the SR group., Results: The mean global rating scale score for the CBC group immediately after the skills course was 4.3, which was maintained 6 months later. There were no significant performance differences between the CBC and SR groups. Both the CBC and SR groups performed significantly better than the JR group (mean global rating scale 3.7; F[2, 15] = 12.269, P < .001)., Conclusion: We conclude that a surgical skills course at the onset of residency is an effective mechanism for teaching targeted technical skills and that skills taught in this manner can have excellent retention rates. Furthermore, an early focus on technical skills allows junior residents to perform at the same level as senior residents for certain tasks and may privilege later learning., (Copyright © 2012. Published by Mosby, Inc.)