Elevating Arthroscopy Skills

By Paul M. Saluan, MD

As orthopaedic surgery faculty members, we have the honor and responsibility for educating future generations of residents and fellows. Yet most faculty have never received formal instruction about how to teach or plan educational experiences. We recognized this opportunity 15 years ago, which led to the genesis of the Orthopaedic Surgery Skills Laboratory at Cleveland Clinic.

The laboratory allows staff to work side-by-side with residents in a wet lab setting, utilizing cadaver specimens to teach surgical skills necessary for developing competence in various orthopaedic surgical techniques. The facility provides the opportunity to elevate mentors’ educational abilities, creates a uniform approach to instruction, and standardizes implementation of procedural-related skills for residents and fellows.

Our Arthroscopy Skills Curriculum, developed shortly after the laboratory was established, has earned the accolades of participants and has been honored externally with a Scholarship in Teaching Award from Case Western Reserve University School of Medicine.

But curriculum and methods need to evolve

A successful curriculum needs to evolve based on evaluation results and changes in resources, targeted learners, and materials requiring mastery.

Subjectively, it appeared that we were achieving our goals of successfully teaching residents and fellows how to perform arthroscopic procedures. And faculty learned how to teach within the format of a laboratory procedural skills curriculum. However, we recognized that opportunities were within our grasp to make the program far more objective, effective and validated. It was time for the next step in our program’s evolution and to take advantage of a plethora of new teaching technologies.

We began by gathering information from colleagues in anesthesia, cardiothoracic surgery, plastic surgery, general surgery, ob/gyn and others at Cleveland Clinic who were in various stages of developing specific skills laboratories. We then evaluated state-of-the-art arthroscopic simulators and began to develop a validated multimedia, web-based, next-generation curriculum.

Next-gen education arrives

Now, our online curriculum is organized into knee, shoulder and hip modules, with elbow and ankle modules soon to follow. We developed videos of attending surgeons and fellows performing or narrating diagnostic arthroscopies. Interactive medical illustrations were embedded in video to demonstrate neurovascular structures at risk and how to avoid them during procedures. We uploaded still images (normal and pathologic), PowerPoint presentations, academic day lectures, and assigned reading from pertinent, evidence-based reference materials.

The arthroscopic simulator is integral to our educational strategy. This objective tool offers various learning opportunities for residents and fellows at all levels of training. Evaluation consists of a pre-test, cognitive online (multiple choice, short answer), motor skills on simulator, a post-test formulated from a bank of test questions developed in-house, and a survey after completion of the course. All test data is assessed prior to a student’s progression to more advanced cases.

The Center for Technology-Enhanced Knowledge and Instruction (CTEKI), housed within Lerner Education Institute at Cleveland Clinic, was instrumental in the translation of our new curriculum into a web-based digital format.

Skills increase, outcomes improve

Our 44 residents, three sports and three shoulder and elbow fellows, plus 10 sports and shoulder/upper extremity physician assistants are the primary participants in this annual academic program led by Department of Orthopaedic Surgery staff.

Students’ post-tests demonstrate definite improvements in arthroscopy skills as well as better arthroscopic anatomic awareness, with measurable effects. In addition, physical therapists and certified athletic trainers are able to observe procedures in the lab, benefitting secondarily through increased knowledge of arthroscopic anatomy and procedural nuances, which may have even larger implications for patients’ postoperative care and rehabilitation.

As we continue to analyze the program’s effectiveness and learner feedback, we anticipate further evolution of our Arthroscopy Skills Curriculum. It has already been proven effective, impactful, measurable and relevant, and has resulted in better patient outcomes by elevating the competence of our trainees.

Dr. Saluan is Director of Pediatric and Adolescent Sports Medicine and an Assistant Professor at Cleveland Clinic Lerner College of Medicine.