Dawn M. LaPorte

The Incidence and Reporting of Sharps Exposure among Medical Students, Orthopedic Residents, and Faculty at One Institution

OBJECTIVEnTo compare the incidence of sharps injuries among medical students, orthopedic residents/fellows, and orthopedic faculty at one institution and to determine the rate of reporting exposures.nnnDESIGNnCross-sectional survey. Surveys were completed by 44% (53/120) of medical students, 76% (23/30) of residents/fellows, and 56% (17/30) of full-time faculty.nnnSETTINGnAcademic medical center.nnnPARTICIPANTSnMedical students, orthopedic surgery residents/fellows, full-time academic orthopedic surgery faculty.nnnRESULTSnTwenty-eight percent of medical students, 83% of residents/fellows, and 100% of faculty had been exposed to a sharps injury at some point in their career; 42% of residents/fellows had experienced a sharps exposure within the past year. The most common single instrument responsible for sharps injuries among all groups was the solid-bore needle; students and residents were significantly more likely than faculty to have a sharps injury from a solid-bore needle than all other devices combined (p = 0.04). Medical students were more likely to ignore the exposure than residents/fellows (p = 0.004) or faculty (p = 0.036). Only 12.5% of medical students followed all the steps of the postexposure protocol.nnnCONCLUSIONnSharps exposures occur among orthopedic surgeons and their trainees. Interventions are needed to increase safety among residents and medical students. Further research should evaluate factors suppressing medical student reporting of sharps exposures.

Compartmental reconstruction for de Quervain stenosing tenosynovitis

We describe a new surgical technique for the treatment of de Quervain tenosynovitis, which consists of lengthening the first dorsal compartment without disruption of continuity and without using a suture. Our results in 12 wrists operated on in 10 patients indicated complete relief of symptoms. The advantages of the technique include: simplicity, restoration of normal anatomy, and prevention of complications (scarring, adhesions, and subluxation of tendons).

Reliability and Validity of 3 Methods of Assessing Orthopedic Resident Skill in Shoulder Surgery.

OBJECTIVEnTraditional measures for evaluating resident surgical technical skills (e.g., case logs) assess operative volume but not level of surgical proficiency. Our goal was to compare the reliability and validity of 3 tools for measuring surgical skill among orthopedic residents when performing 3 open surgical approaches to the shoulder.nnnMETHODSnA total of 23 residents at different stages of their surgical training were tested for technical skill pertaining to 3 shoulder surgical approaches using the following measures: Objective Structured Assessment of Technical Skills (OSATS) checklists, the Global Rating Scale (GRS), and a final pass/fail assessment determined by 3 upper extremity surgeons. Adverse events were recorded. The Cronbach α coefficient was used to assess reliability of the OSATS checklists and GRS scores. Interrater reliability was calculated with intraclass correlation coefficients. Correlations among OSATS checklist scores, GRS scores, and pass/fail assessment were calculated with Spearman ρ. Validity of OSATS checklists was determined using analysis of variance with postgraduate year (PGY) as a between-subjects factor. Significance was set at p < 0.05 for all tests.nnnRESULTSnCriterion validity was shown between the OSATS checklists and GRS for the 3 open shoulder approaches. Checklist scores showed superior interrater reliability compared with GRS and subjective pass/fail measurements. GRS scores were positively correlated across training years. The incidence of adverse events was significantly higher among PGY-1 and PGY-2 residents compared with more experienced residents.nnnCONCLUSIONnOSATS checklists are a valid and reliable assessment of technical skills across 3 surgical shoulder approaches. However, checklist scores do not measure quality of technique. Documenting adverse events is necessary to assess quality of technique and ultimate pass/fail status. Multiple methods of assessing surgical skill should be considered when evaluating orthopedic resident surgical performance.

Sensory Innervation of the Triangular Fibrocartilage Complex: A Cadaveric Study

PURPOSEnTo describe the sensory innervation of the triangular fibrocartilage complex (TFCC) to understand the potential for selective denervation as an alternative treatment for recalcitrant pain from stable TFCC IA lesions after failed nonsurgical treatment.nnnMETHODSnEleven fresh cadaveric limbs were dissected with × 3.2 loupe magnification in a proximal to distal manner. The candidate nerves were the dorsal cutaneous branch of the ulnar nerve, volar sensory branch of the ulnar nerve, anterior interosseous nerve, posterior interosseous nerve, medial antebrachial cutaneous nerve, and palmar cutaneous branch of the median nerve. We identified neural continuity to the TFCC histologically with S-100 protein antibody staining.nnnRESULTSnIn the 11 specimens, the TFCC was innervated by the dorsal cutaneous branch of the ulnar nerve (100%), medial antebrachial cutaneous nerve (91%), volar branch of the ulnar nerve (73%), anterior interosseous nerve (27%), posterior interosseous nerve (18%), and palmar branch of the median nerve (9%).nnnCONCLUSIONSnThese results provide an initial step in planning an operative partial TFCC denervation for recalcitrant TFCC IA injuries that fail nonsurgical treatment and possibly also arthroscopic debridement.nnnCLINICAL RELEVANCEnBased on the results of this anatomic study, it is possible to create an algorithm for performing nerve blocks of the TFCC that would aid in planning a surgical denervation procedure.

Post-interview Communication During Application to Orthopaedic Surgery Residency Programs

BACKGROUNDnPost-interview communication from residency programs to applicants is common during the U.S. residency match process. The goals of this study were to understand the frequency and type of post-interview communication, how this communication influences applicants ranking of programs, whether programs use second-look visits to gauge or to encourage applicant interest, and the financial costs to applicants of second-look visits.nnnMETHODSnA post-match survey was sent to 1,198 applicants to one academic orthopaedic residency program over 2 years. The response rates were 15% in 2014 and 31% in 2015, totaling 293 responses used for analysis.nnnRESULTSnSixty-four percent of applicants reported having post-interview communication with one or more programs. Seventeen percent said that communication caused them to rank the contacting program higher or to keep the program ranked as number 1. Twenty percent felt pressured to reveal their rank position, and 8% were asked to rank a program first in exchange for the programs promise to rank the applicant first. Applicants who received post-interview communication had odds that were 13.5 times higher (95% confidence interval, 6.2 to 30 times higher) of matching to the programs that contacted them. Ninety percent of applicants said that communication from a program did not change how they ranked the program with which they eventually matched. Seventeen percent were encouraged to attend second-look visits, incurring a mean cost of

Musculoskeletal education in medical school: deficits in knowledge and strategies for improvement.

600 (range,

A survey of current policy and practice of surgical exposure for preclerkship medical students at American medical institutions.

20 to

An Analysis of the Orthopaedic In-Training Examination Rehabilitation Section

8,000).nnnCONCLUSIONSnOrthopaedic residency programs continue to communicate with applicants in ways that violate the National Resident Matching Programs Match Communication Code of Conduct, and they continue to encourage second-look visits. To improve the integrity of the match, we suggest that programs use no-reply e-mails to minimize influence and pressure on applicants, interviewers and applicants review the Code of Conduct on interview day and provide instructions on reporting violations to the National Resident Matching Program, all post-interview communication be directed to a standardized or neutral third party, and programs actively discourage second-look visits and stop requiring second-look visits.

Preoperative Evaluation for Hand Surgery in Adults

➤ Improvements in medical student physical examination skills and performance on validated musculoskeletal competency examinations correspond with undergraduate curricular reform.➤ Curricular reform success in the United States has been achieved by multidisciplinary collaboration.➤ International efforts are focused on improving medical student physical examination skills through patient partners and structured clinical examinations.➤ Technologies such as simulators and online learning tools are effective and well received.

Monitored Anesthesia Care for Hand Surgery in Adults

BACKGROUNDnThe goals of this study were to (1) determine the extent of preclerkship surgical participation in American medical colleges; (2) examine policies regarding such surgical participation; and (3) elicit medical school administrators perceptions about such exposure.nnnMETHODSnSurveys were sent to 128 accredited medical schools (1 administrator each). The 54 (42%) replies were analyzed using descriptive statistics and Students t tests, with significance defined as a P value of ≤ .05.nnnRESULTSnOf the respondents, 55.6% did not permit student surgical participation. Only 22.2% of responding institutions offered preclerkship surgical skills electives. Administrators from the former group of schools perceived significantly greater risk (P = .001) to patient safety with student surgical participation than did administrators at schools permitting such participation, even though no respondents reported malpractice or workers compensation cases arising from student participation.nnnCONCLUSIONSnMedical students have limited opportunities for preclerkship surgical participation at most American medical institutions, possibly because of unsubstantiated concerns for patient safety.