A Basic Surgical Skills Curriculum for PGY1 Training

Our 2012 experience M. Daniel Wongworawat, MD Professor and Program Director Loma Linda University

Disclosures • Committee/Board Appointments • • AAOS Chair, Central Evaluations Committee (OITE/OSAE/OSIE) • • ASSH Self-Assessment Examination Committee • • San Bernardino County Medical Society Vice President • • ABOS/AAOS/AOA/CORD PGY-1 Surgical Skills Taskforce • Editorial Board • Senior Editor, Clinical Orthopaedics and Related Research • Stock ownership • Stryker, Medtronic, Amgen

Overview • Needs assessment based on semi-annual program evaluation meeting in 2011/2012 • Focus on low-tech options • Course objectives • Perform sharp and dull dissection • Place deep, dermal, subcuticular sutures and secure knots • Operate power drill, saw, wire driver • Place K-wires, lag screws, compression plates, locking plates, tension bands • Operate basic arthroscopy equipment

Methods • Content divided into four modules • Supervised by faculty members • Tasks deconstructed into components • One day per week, over four weeks • Modules Soft tissue handling Power tool operation Bone handling Arthroscopy

Soft tissue handling • Fresh pork belly

Soft tissue handling • Fresh pork belly • Muscle fascial planes • Dermal layer • Incision • Scissor dissection along planes • Suture placements • Simple • Mattresses • Inverted dermals • Subcuticular • Knot tying

Power tool operation • Introduction to: • Stryker cordless • K-wire driver/collets • Drill chuck • Quick release chuck • Oscillating saw

Basic bone handling • K-wire and oscillating saw skills • 10-cc syringe Numbers as targets Transverse wire placement Oblique wire placement Sawbones humerus Saw cuts Neck fractures Supracondylar fractures Wire fixation Visualized Under towel-wrapped envelope

Basic bone handling • Concepts discussion • Screw placement • Lag technique • Plate fixation • • • Neutralization Compression Locked • Tension band placement

Basic arthroscopy • • Scope operation 30 ° angle • Triangulation • Instrument handling • Knot tying board • Visualized knot tying • Visualized through clear cannula • Visualized on monitor

Post course evaluations, 2012 • Good feedback from learners • Goals met • Suggestions for improvement • • • • Include closed reduction techniques Include splinting and casting Expand modules Increase time dedication

Future direction • Expansion of modules • Dedicated month • Improvement of assessments checklist • Checklist validation • … introduction to PGY-1 Surgical Skills Taskforce • • Joint project of AAOS/ABOS/AOA/CORD Led by J. Lawrence Marsh

Thank You