A randomized pilot validation of educational measures in teaching shoulder arthroscopy to surgical residents

Abstract

Background: Injuries to the shoulder joint commonly require the attention of an orthopedic surgeon. Shoulder arthroscopy plays an increasingly important role in the diagnosis and repair of shoulder pathology; however, the most effective manner in which to teach orthopedic residents fundamental knowledge of diagnostic shoulder arthroscopy before entering the operating room is unclear. We aimed to compare the existing cadaver-based teaching of diagnostic shoulder arthroscopy knowledge with a method that combines model- and video-based teaching to orthopedic surgery residents in a randomized pilot trial.

Methods: A composite (model/video teaching) method was designed, using prepared teaching videos and the commercially available ALEX shoulder arthroscopy model. First- and second-year orthopedic surgery residents from the University of Calgary were consented, surveyed for their arthroscopy experience and randomized to either cadaver or composite teaching. Subjects wrote a pretest before their teaching session and a posttest afterwards to assess their knowledge of diagnostic arthroscopy. The tests were multiple choice, containing text and pictorial-based questions. The posttest was modified to minimize recall bias. Subjects were also surveyed for their comments regarding the teaching sessions.

Results: Nine of 10 subjects increased their test scores after the teaching sessions, with 4 of 5 in the cadaver-based and 5 of 5 in the composite groups. There were no differences between the teaching groups on their mean pre- or posttest scores. The composite group, but not the cadaver-based group, had a statistically significant increase in posttest scores. When the text- and pictorial-based question sections were analyzed separately, both groups significantly improved their mean text-based score, whereas only the composite group increased their mean pictorial-based questions score. Surveying the residents elicited positive comments regarding both manners of teaching.

Conclusion: This pilot trial suggests that a composite teaching curriculum is at least as effective as a cadaver-based environment for teaching orthopedic surgery residents fundamental knowledge of diagnostic shoulder arthroscopy.

FIG. 1. Arthroscopy teaching model. The ALEX teaching model of a left shoulder employed during the composite teaching group. This model can mimic normal and pathological shoulder anatomy and arthroscopy portals and can also can be fitted with an opaque or transparent cover.,

FIG. 2. Individual subject scores on the pre-and posttests. Left: individual subject test scores from the cadaver-based teaching group. Subject 6 experienced a 1-point decrease in the posttest score, while subject 8 achieved the highest margin of improvement among all subjects. Right: individual subject test scores from the composite (model/video) group.

FIG. 3. Pre-and posttest mean scores. The cadaver-based group scored 20.8 (standard error of mean [SEM] 1.98) on the pretest and 25.4 (SEM 1.12) of a possible 34 marks on the posttest, a nonsignificant difference. The composite (model/ video) group scored 18.2 (SEM 0.66) on the pretest and 24.8 (SEM 1.02) on the posttest, a significant improvement. Difference pretest means 2.6; p = 0.2493; 95% CI 2.23 to –7.43. Difference posttest means 0.6; p = 0.7027; 95% CI 2.90 to –4.10.

FIG. 4. Subsection test results. Left: subsection test scores from subjects in the cadaver teaching environment show no significant improvement in the pictorial based questions (8 possible marks) but a significant improvement in the text-based questions (26 possible marks). Right: subjects taught in the composite environment significantly improved their test scores in both categories (statistics by paired t test).