The Journal of Hip Surgery 2019; 03(03): 124-129
DOI: 10.1055/s-0039-1694766
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopy Volume in United States Residency Programs: Are New Trainees Prepared?

1   Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Alan G. Shamrock
1   Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Kyle R. Duchman
1   Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
2   Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina
,
Natalie A. Glass
1   Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
T. Sean Lynch
3   Department of Orthopedic Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York
,
Robert W. Westermann
1   Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
› Author Affiliations
Funding No external sources of funding were used for this study.
Further Information

Publication History

30 November 2018

28 June 2019

Publication Date:
07 August 2019 (online)

Abstract

Arthroscopy is a technically demanding procedure with a prolonged learning curve. The purpose of this study is to determine if current arthroscopic case volume over the course of an orthopaedic surgery residency is sufficient to meet the number of cases required to achieve competence and/or mastery in complex arthroscopic tasks as well as hip arthroscopy. Publicly available Accreditation Council for Graduate Medical Education case log data for arthroscopic procedures from accredited orthopaedic residencies were reviewed from 2007 to 2017. Linear and segmental regression analyses were used to identify temporal trends, with significance set to p < 0.05. From 2007 to 2013, there was a significant increase in the median number of shoulder and knee arthroscopy case logs (p < 0.001). A sharp decline in the median number of shoulder and knee arthroscopy case logs was seen in 2013 to 2014 (p < 0.001), and the number remained low from 2014 to 2017 (p = 0.02, p = 0.03). The median number of hip arthroscopy procedures logged increased significantly from zero cases in 2012 (range: 0–48 cases) to five cases in 2017 (range: 0–76 cases) (p = 0.02). Over the study period, the median number of total arthroscopic procedures decreased from 301 to 186 (p = 0.01). In the United States, the majority of orthopaedic surgery residents graduate with case log numbers that meet theoretical minimum requirements for competence in basic diagnostic arthroscopy of the shoulder, hip, and knee. Resident experience with hip arthroscopy has increased; however, the majority of residents are graduating with little to no hip arthroscopy experience. Moreover, the median number of total arthroscopic procedures has declined to the point where the average graduate may not be able to perform complex hip or shoulder arthroscopy tasks based on previously published data. These findings support the need for further investigation into the best methods for training residents interested in performing arthroscopy as part of their careers. This was a level of evidence III, retrospective cohort study.

The study was performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.


 
  • References

  • 1 Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National trends in rotator cuff repair. J Bone Joint Surg Am 2012; 94 (03) 227-233
  • 2 Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93 (11) 994-1000
  • 3 Montgomery SR, Ngo SS, Hobson T. , et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy 2013; 29 (04) 661-665
  • 4 Bozic KJ, Chan V, Valone III FH, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplasty 2013; 28 (8, Suppl): 140-143
  • 5 Hinds RM, Gottschalk MB, Strauss EJ, Capo JT. Trends in arthroscopic procedures performed during orthopaedic residency: an analysis of Accreditation Council for Graduate Medical Education case log data. Arthroscopy 2016; 32 (04) 645-650
  • 6 Colvin AC, Harrast J, Harner C. Trends in hip arthroscopy. J Bone Joint Surg Am 2012; 94 (04) e23
  • 7 Werner BC, Burrus MT, Park JS, Perumal V, Gwathmey FW. Trends in ankle arthroscopy and its use in the management of pathologic conditions of the lateral ankle in the United States: a national database study. Arthroscopy 2015; 31 (07) 1330-1337
  • 8 Duchman KR, Westermann RW, Glass NA, Bedard NA, Mather III RC, Amendola A. Who is performing hip arthroscopy?: an analysis of the American Board of Orthopaedic Surgery Part-II Database. J Bone Joint Surg Am 2017; 99 (24) 2103-2109
  • 9 Mehta N, Chamberlin P, Marx RG. , et al. Defining the learning curve for hip arthroscopy: a threshold analysis of the volume-outcomes relationship. Am J Sports Med 2018; 46 (06) 1284-1293
  • 10 Erturan G, Alvand A, Judge A, Pollard TCB, Glyn-Jones S, Rees JL. Prior generic arthroscopic volume correlates with hip arthroscopic proficiency: a simulator study. J Bone Joint Surg Am 2018; 100 (01) e3
  • 11 Middleton RM, Vo A, Ferguson J. , et al. Can surgical trainees achieve arthroscopic competence at the end of training programs? A cross-sectional study highlighting the impact of working time directives. Arthroscopy 2017; 33 (06) 1151-1158
  • 12 Gil JA, Waryasz GR, Owens BD, Daniels AH. Variability of arthroscopy case volume in orthopaedic surgery residency. Arthroscopy 2016; 32 (05) 892-897
  • 13 Accreditation Council for Graduate Medical Education. Case Log Statistical Reports, 2007–2017; 2018. Available at: https://www.acgme.org/Data-Collection-Systems/Case-Log-Statistical-Reports . Accessed July 7, 2018
  • 14 Accreditation Council for Graduate Medical Education. Review Committee for Orthopaedic Surgery - Case Log Guidelines; 2014. Available at: http://www.acgme.org/portals/0/pfassets/programresources/260_case_log_guidelines.pdf . Accessed July 7, 2018
  • 15 Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002; 27 (04) 299-309
  • 16 Price AJ, Erturan G, Akhtar K, Judge A, Alvand A, Rees JL. Evidence-based surgical training in orthopaedics: how many arthroscopies of the knee are needed to achieve consultant level performance?. Bone Joint J 2015; 97-B (10) 1309-1315
  • 17 ACGME Review Committee for Orthopaedic Surgery. Orthopaedic Surgery Minimum Numbers: 2014 . Available at: https://www.acgme.org/Portals/0/PFAssets/ProgramResources/260_ORS_Case_Log_Minimum_Numbers.pdf . Accessed July 7, 2018
  • 18 Howells NR, Gill HS, Carr AJ, Price AJ, Rees JL. Transferring simulated arthroscopic skills to the operating theatre: a randomised blinded study. J Bone Joint Surg Br 2008; 90 (04) 494-499
  • 19 Cannon WD, Garrett Jr WE, Hunter RE. , et al. Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator. A randomized blinded study. J Bone Joint Surg Am 2014; 96 (21) 1798-1806
  • 20 Waterman BR, Martin KD, Cameron KL, Owens BD, Belmont Jr PJ. Simulation training improves surgical proficiency and safety during diagnostic shoulder arthroscopy performed by residents. Orthopedics 2016; 39 (03) e479-e485
  • 21 Rebolledo BJ, Hammann-Scala J, Leali A, Ranawat AS. Arthroscopy skills development with a surgical simulator: a comparative study in orthopaedic surgery residents. Am J Sports Med 2015; 43 (06) 1526-1529
  • 22 Okike K, Berger PZ, Schoonover CO, Toole RV. Do orthopaedic resident and fellow case logs accurately reflect surgical case volume?. J Surg Educ 2018; 75 (04) 1052-1057
  • 23 Cadish LA, Fung V, Lane FL, Campbell EG. Surgical case logging habits and attitudes: a multispecialty survey of residents. J Surg Educ 2016; 73 (03) 474-481
  • 24 McClure PK, Woiczik M, Karol L, Sankar WN. Variation in national ACGME case log data for pediatric orthopaedic fellowships: are fellow coding practices responsible?. J Pediatr Orthop 2017; 37 (05) e329-e334