American Board of Orthopaedic SurgeryEstablishing Education & Performance Standards for Orthopaedic Surgeons

ABOS/CORD Surgical Skills Assessment ProgramABOS Essential Knowledge, Skills, and Behaviors Task Force

Purpose

• Your program is participating in a process to allow faculty to assess resident surgical skills in performing certain orthopaedic procedures.

• The resident is responsible for requesting assessments on specific cases.

• The faculty is responsible for completing the assessments.

• Completed assessments are sent back to the resident for documentation and feedback real-time.

Background: Goals of Process

• Orthopaedic surgeons are surgeons. In addition to knowledge and behavior, assessment of surgical skills is an important aspect of evaluating competence.

• Competence in medical knowledge has been developed, but a deficiency exists in documenting competence in surgical skills.

Background: Why is a new tool necessary?

• Presently, the residency program director attests that the graduate has completed 60 months of training in an ACGME accredited residency program and is “competent in the independent practice of orthopedic surgery”.

• The ABOS, representing the public interest, desires greater documentation of surgical skills competence of individual candidates during residency training.

Methods

• Each G2-G5 resident requests at least one assessment each week that the resident participates in any of the listed procedures (currently 25 milestone procedures and 10 additional common procedures).

Interface

• A mobile-optimized web page to request an evaluation: • The resident logs in, selects the procedure/date/time/faculty, and click

Send. The evaluator receives a text/email with a link to be taken to the assessment form.

• The assessment form is a mobile-optimized web page with one question per page. Faculty using smartphones with dictation capability may dictate the feedback comments.

. V.

Resident requests faculty evaluation by sending email or text request real-time

I have a list of 35 procedures that I need to be evaluated on. Can you evaluate my performance on the IM TibialRod we are going to do? I will send you a text at the end of the surgery.

Of course. I will be sure to make

careful observations

15 MILESTONES 25 PROCEDURES Definition

Anterior Cruciate Ligament Performs diagnostic arthroscopy with notchplasty, and/or graft harvest Level 3

Performs graft passage and fixation Level 4

Ankle Arthritis Performs straightforward ankle/midfoot fusions Level 4

Ankle Fracture Performs ORIF of simple ankle fx (bimalleolar) Level 3

Performs ORIF of moderately complex ankle fx (trimalleolar, pilon) Level 4

Carpal Tunnel Performs Carpal Tunnel Release Level 4

Degenerative Spine Performs Exposure C or L-spine Level 3

Decorticates for PSF Level 4

Diaphyseal Femur and Tibia Fx Performs Simple IM Nail Tibia Level 4

Performs Simple IM Nail Femur Level 4

Distal Radius Fracture Performs ORIF extra-articular Level 3

Performs ORIF Intra-articular Level 4

Adult Elbow Performs ORIF olecranon fx Level 3

Performs ORIF distal humerus fx Level 4

Hip and Knee Arthritis Performs Primary THA Level 4

Performs Primary TKA Level 4

Hip Fracture Performs ORIF stable hip fx Level 3

Performs ORIF complex hip fx Level 4

Metastatic Bone Lesion Performs ORIF pathologic or impending fx Level 4

Meniscal Tear Performs diagnostic scope/debride Level 3

Performs meniscal repair Level 4

Pediatric Septic Hip Performs hip arthrotomy/drainage Level 4

Rotator Cuff Injury Performs diagnostic shoulder scope, decompression Level 3

Performs Rotator Cuff Repair Level 4

Pediatric Supracondylar Fracture Performs CR/PP Level 4

ADDITIONAL COMMON PROCEDURES

Debridement of open fx

Lumbar laminectomy

Lumbar discectomy

Removal of deep implant

Tendon sheath incision (trigger finger)

Ulnar nerve transposition

ORIF clavicle fx

Primary total shoulder arthroplasty

Excision of ganglion, wrist

Excision of lesion of tendon sheath or joint capsule, hand/finger

Placement of pedicle screw

Exposure for idiopathic scoliosis

Epiphysiodesis/8 plates

Irrigation and Debridement and THA/TKA Liner Exchange

. V.

Resident requests faculty evaluation by sending email or text request real-time

I just got a text from my resident to evaluate his performance on the surgery. This will be quick and easy, so I will complete it right now while I remember! The text links to a web-based evaluation.

Formative Evaluation for 8 Steps of Surgical Procedure

1. Pre-procedure plan: Gathers/assesses required information to reach diagnosis and determine correct procedure required

2. Case preparation: Patient correctly prepared and positioned, describes approach and lists required instruments, prepared to deal with probable complications

3. Knowledge of specific procedural steps: Can sequence steps of procedure, articulates potential risks, and means to avoid/overcome them

4. Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues

5. Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended

6. Post-procedure plan: Appropriate complete post procedure plan

7. Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

8. Communication: Professional and effective communication/utilization of staff

5 Point Ottawa Surgical Competency Operating Room Evaluation

1. “I had to do”—i.e., requires complete hands on guidance, did not do, or was not given the opportunity to do.

2. “I had to talk them through”—i.e., able to perform tasks, but requires constant direction.

3. “I had to prompt them from time to time”—i.e., demonstrates some independence, but requires intermittent direction.

4. “I needed to be in the room just in case”—i.e., independence, but still requires supervision for safe practice.

5. “I did not need to be there”—i.e., complete independence, understands risks and performs safely, practice ready.

5 Point SummativeComments Field: Feedback to residents including targeted areas for improvement

1. Novice: Attending surgeon provides maximum assistance. Demonstrates knowledge of anatomy. Demonstrates basic operative skills (e.g., incision, excision, wound closure). Positions patient. First assists and observes.

2. Low Intermediate: Attending surgeon provides significant assistance and direction. Performs approach with minimal assistance. Identifies anatomical landmarks. Identifies most of the critical steps. Demonstrates proficiency with the component technical skills. Demonstrates an increasing ability to perform different key parts of the operation with attending assistance. Demonstrates room set up and equipment management.

3. High Intermediate: Attending provides modest assistance and direction. Capable of performing the approach. Familiar with anatomic landmarks. Identifies and is capable of performing almost all of the critical steps. Demonstrates proficiency with the component technical skills. Attending assistance required for the most challenging portions of the procedure.

4. Competent – requires only supervision: Attending Surgeon not required to provide active assistance. Knows steps and transitions easily. Able to direct and assist a more junior resident. Aware of environment and can manage patient safety and coordinate the operation team. Capable of performing the procedure in practice independently.

5. Advanced Expertise: Performance matches that of advanced surgeon. Capable of performing complex procedures independently. Capable of independent management of intraoperative complications.

Feedback to Resident

• Once submitted, the resident receives a text/email informing him/her that the assessment has been completed with a link to view the assessment.

• Each resident has a My Skills Assessmentspage, showing the assessment scores for each procedure. Clicking on an assessment shows the completed assessment form.

. Now I know where I am at and what I need to work on!.

17 SKILLS MODULES

Module 1 Sterile Technique - Operating Room Setup

Module 2 Suturing and Knot Tying

Module 3 Microsurgical Suturing Technique

Module 4 Soft Tissue Handling and Dissection

Module 5 Casting and Splinting: Splints, Casts, and Removal

Module 6 Traction Techniques

Module 7 Compartment Syndrome: Diagnosis and Treatment

Module 8 Bone Handling Techniques - Osteotomy

Module 9 Fluoroscopic Knowledge and Skills

Module 10 K-Wire Techniques

Module 11 Techniques Basic to Internal Fixation of Fractures

Module 12 Principles and Techniques of Fracture Reduction

Module 13 Basics Techniques in External Fixation

Module 14 Basic Arthroscopy Skills

Module 15 Basic Arthroplasty Skills (TKA & THA)

Module 16 Joint Aspiration and Injection

Module 17 Patient Safety, Team Training, Obtaining Consent

G1 Skills Modules may also be assessed

Login: https://www.abos.org/r

Skills Assessment Request

Skills Assessment Request Confirmation

Skills Assessment Request Email

Skills Assessment: Case Complexity

Skills Assessment: Pre-Procedure Plan

O-Score Rating System

Skills Assessment: Case Preparation

Skills Assessment: Knowledge of Specific Procedural Steps

Skills Assessment: Technical Performance

Skills Assessment: Visuospatial Skills

Skills Assessment: Post-Procedure Plan

Skills Assessment: Efficiency and Flow

Skills Assessment: Communication

Skills Assessment: P-Score (Global Evaluation)

P-Score Rating System

P-Score Rating System

Skills Assessment: Feedback to Resident

Skills Assessment Results Confirmation

Skills Assessment Results Email

Other Online Functions

• View My Skills Assessments

• View and update My Profile

• Select contact preference (email or text) on My Profile

My Skills Assessment

My Profile

Program Director Online Functions

• View All Skills Assessments

• View Milestones Report

• View, add to, and update roster of Residents

• Download Resident List

• View and update Faculty

• View and update My Profile

All Skills Assessments

Reports: Milestones Report

Milestones Report

Resident Roster

Faculty/Attending

My Profile