A Surgical Skills Rotation for Mid-Level Residents

Abstract

Introduction: The University of Iowa orthopaedic residency previously designed a month-long surgical skill rotation for postgraduate year (PGY)-1 residents. This successful initiative has become a model of interest for other teaching institutions. In addition to the intern year, an important phase in residency occurs during the transition from PGY2 to PGY3, when residents assume greater responsibility and autonomy in leading surgical procedures.

Methods: To directly address this transition and assess residents' readiness, our residency program established a week-long PGY2 surgical skills rotation. This rotation serves as a training checkpoint and focuses on both training and evaluation of level-appropriate skills in joint arthroplasty, trauma, arthroscopy, and wire navigation. The primary objective of the PGY2 surgical skills rotation is to enhance orthopaedic residents' operative skills and experience by providing increased exposure and practice of requisite technical skills. Similar to the Orthopedic In-Training Examinations that assess residents' knowledge, this week-long program, aimed at assessing residents' proficiency in fundamental orthopaedic technical skills, occurs before their PGY3 year.

Results: Faculty-led training and assessment sessions in each area offer residents many opportunities for dedicated practice and improvement. Transferring these acquired skills from the laboratory to the operating room is essential for a training program. To confirm improvement, the final day of the surgical skills rotation was exclusively dedicated to structured performance evaluations, with a specific emphasis on establishing proficiency benchmarks.

Conclusion: We herein describe the University of Iowa's PGY2 surgical skills rotation, providing insights into its development, implementation, and outcomes. By sharing our experience, we offer a framework for other academic departments seeking to optimize surgical skills education and ensure the successful transition of mid-level residents.

Fig. 1

Essential learning objectives in planning the curriculum.

Fig. 2

2021 skills week schedule. IDEA = score image-based decision error analysis, ORIF = open reduction and internal fixation, OSATS = objective structured assessment of technical skills, and O-Score = Ottawa surgical competency operating room evaluation.

Fig. 3

PGY2 residents completing skills laboratories and simulations on assessment day.

Fig. 4

Scorecards provided detailed assessments to the residents on each of the procedures assessed on the last day of the week. The O&P score provides detailed feedback on the cadaveric assessments with grades of 1 to 5 (5 indicating highest performance) on various categories identified in evaluating performance. The arthroscopic scores are based on different elements such as procedure duration, camera path length, probe path length, and camera alignment. The feedback on the wire navigation simulator tasks is based on a combination of the time to complete the procedure, the number of fluoroscopy images taken during the task, the accuracy of the pin position, and the path that is taken to achieve the pin position. A summative score combines these elements to provide an overall grade, with positive scores indicating a stronger performance and negative scores indicating room for improvement.

Fig. 5

O-Score Scale.

Fig. 6

P-Score Scale.