The Development and Execution of An Orthopaedic Sports Medicine Fellowship Surgical Skills Assessment.

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.
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by funding from The Aircast Foundation. C.L.C. has received consulting fees from Arthrex. M.J.M. has received consulting fees from Breg Inc, Arthrex Inc, Ostesys, Heron Therapeutics, and Schwartz Biomedical; and support for education from Elite Orthopedics; he is chair of the NFL research and innovation committee. J.R.D. has received consulting fees from Arthex Inc, DJO, and Royal Biologics; royalties from Arthrex Inc and In2Bones; research support from Mitek, Smith + Nephew, Arthrex Inc, and Biomet; and hospitality payments from Stryker; he has stock options in Topical Gear. A.S.R. has received consulting fees from Smith + Nephew, Anika, NewClip, Cervos, Moximed, ConMed, Bodycad, Arthrex, Flexion Therapeutics, Stryker, Heron Therapeutics, and Xiros; and payments for educational support from Gotham Surgical Solutions and Devices; he has stock or stock options in Enhatch and Conformis. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.