A Surgical Skills Training Curriculum for PGY-1 Residents

1. A Surgical Skills Training Curriculum for PGY-1 Residents J. Lawrence Marsh, MD*; Matthew Karam, MD; TameemYehyawi, MD; Brian Westerlind, BA, JennieferKho, MD, Donald Anderson, PhD The University of Iowa Orthopaedic Surgery Residency Training Program

2. Acknowledgments Funded by OMeGA Medical Grants Association and NIH/NIAMS (AR055533 and AR054015) and OTA Research Grant and NBME Stemmler

3. Disclosure • Chair of a ABOS Surgical Skills Taskforce (SSTF) currently producing a parallel modular curriculum (July 2013) • Director of the ABOS • Chair of the Orthopaedic Residency Review Committee (RRC)

4. Introduction • Orthopedic Surgery requires a high degree of technical skill • Skills are acquired during residency and fellowship training through an apprenticeship model largely unchanged for over a century.

5. Results of a 2011 National Orthopaedic Program Director and Resident Survey – Karam and Marsh JBJS 2012 • Only 50% of residency programs have a skills lab and program. • There is high interest among PD’s in a skills curriculum. • Most PD’s have little knowledge of the budget for skills training or the cost of a skills lab • Cost is a challenge to expansion of skills programs

6. Interest in a curriculum?

7. The American Board of Orthopaedic Surgery (ABOS) and the Residency Review Committee (RRC) will require a laboratory based surgical skills training program beginning Academic year 2013-2014. Requirements include: • A curriculum with goals and objectives • Assessment metrics • A dedicated space for the skills training. • Training in basic skills required of residents for emergency care and to prepare residents for future participation in surgical procedures.

8. To meet these requirements! The Univ. of Iowa Department of Orthopaedics has: • Developed a curriculum that considered cost and time commitments • Used a one month format with a dedicated space for training • Tried to provide a foundation for future surgical skills development

10. Asepsis, instruments Knot tying Suturing Tissue handling, wound management Advance tissue handling, flaps, grafts Catheterization Airway management Chest tubes Central lines Surgical biopsy Vascular anastomosis Laparotomy Bone fixation, casting Inguinal anatomy Upper endoscopy Colonoscopy Basic laparoscopic skills Advanced laparoscopic skills Hand sewn GI anastomosis Stapled GI anastomosis ACS/APDS as a modelPhase I Curriculum Modules

11. University of Iowa Modules

12. University of Iowa Modules

13. University of Iowa staff support for this project • 9 months ahead project committed by department • Met five times as a group • Worked individually on modules • Specific dates decided 3 months ahead • 14 Faculty: J Lawrence Marsh, MD; Matthew Karam, MD; Nicolas Noiseux, MD; Brian Wolf, MD; Ryan Ilgenfritz, MD; Ericka Lawler, MD; Benjamin Miller, MD; Apurva Shah, MD; John Femino, MD PhinitPhisitkul, MD; Mederic Hall, MD; Donald Anderson, MD; Melissa Willenborg, MD; and Sergio Mendoza, MD. These faculty members were involved and devoted significant time in each step of the process from module development to instruction during the individual modules. • 3 Support Staff: Janelle Campbell , Jessica Kozlowski, Brian Westerlind, UIHC Radiology.

14. Modules(ABOS Modules) • Sterile technique and operating room set up • Knot tying & suturing • Microsurgical suturing • Soft tissue handling techniques • Casting and splinting • Traction • Compartment syndrome • Bone handling techniques • Fluoroscopy • K-wire techniques • Basic techniques in ORIF • Principles and techniques of fracture reduction • External fixation  • Basic Arthroscopy skills • Basics of Arthoplasty • Joint injection • Patient Safety

15. January 2013 Some call on weekend no other clinical work All 6 PGY 1’s

21. Additionally, there is a current parallel project sponsored by: • The American Board of Orthopaedic Surgery (ABOS) With additional support from: • American Orthopaedic Association (AOA)/Council Of Residency Directors (CORD) • The American Association of Orthopaedic Surgery (AAOS)

22. Members of the ABOS Surgical Skills Task Force • J. Lawrence Marsh, MD – Chair (ABOS) • James E. Carpenter, MD (ABOS) • Shepard R. Hurwitz, MD (ABOS) • Michelle A. James, MD (ABOS) • Joel T. Jeffries, MD (AOA/CORD) • David F. Martin, MD (ABOS) • Peter M. Murray, MD (ABOS) • Bradford O. Parsons, MD (AAOS) • Robert A. Pedowitz, MD, Ph.D. Co-Chair (AAOS) • Brian C. Toolan, MD (AAOS) • Ann E. Van Heest, MD (AOA/CORD) • M. Daniel Wongworawat, MD (AAOS)

23. Summary and Conclusions • Considerable time invested in the planning and execution but faculty members were engaged and eager to contribute. • The greatest expense was for cadaveric specimens. With better planning and with different and more cost effective simulations, this expense could be reduced. • The video content produced should allow residents to learn more independently, and decrease the faculty time commitment. Video will be available through the parallel project created by the ABOS/AAOS/AOA/CORD project.

24. Summary and Conclusions • Resident satisfaction was high. • Next year we will develop better assessment metrics and assess the relative value of each of the modules • This experience suggests a dedicated month of surgical simulation has potential to change the paradigm of skills training for junior residents.

25. For further information or questions, please contact: J. Lawrence Marsh, MD The University of Iowa Hospitals and Clinics: Department of Orthopaedics and Rehabilitation 200 Hawkins Drive 01071 JPP • Iowa City • Iowa • 52242 j-marsh@uiowa.edu