Veronica Wadey

Learning Styles of First-Year Orthopedic Surgical Residents at 1 Accredited Institution

BACKGROUND This study represents 1 arm of a 5-year prospective study investigating the learning styles of orthopedic residents and their surgical educators. METHODS This project investigates the learning styles of the 2009-2010 year 1 orthopedic surgical residents. A cross-sectional survey using the Kolb Learning Style Inventory was completed by 13 first year orthopedic residents. Direct 1-to-1 interviews were completed with the primary investigator and each participant using the Kolb Learning Style Inventory and learning styles were determined. RESULTS Converging learning style was the most common among the residents (53.8%). Residents demonstrated a high tendency toward the learning skill of abstract conceptualization combined with active experimentation, and a transition from action-oriented to more reflective learning style with age and postgraduate education. CONCLUSIONS These results may be useful in creating strategies specific to each learning style that will be offered to residents to enhance future teaching and learning.

Use and cost-effectiveness of intraoperative acid-fast bacilli and fungal cultures in assessing infection of joint arthroplasties.

The objective of this study is to determine a protocol for collecting acid-fast bacilli (AFB) and fungal intraoperative cultures during orthopedic procedures. An observational study was undertaken. Four hundred forty-six AFB cultures and 486 fungal cultures were processed over a 2-year period. The number of positive cultures was determined. A protocol specific to handling these types of specimens was developed. Cost analysis was completed to determine both the time and money saved if the new protocol was implemented. The infrequency of positive AFB and fungal cultures in this study suggests that it is only necessary to routinely request AFB and fungal cultures on 1 of 5 samples. Implementation of this protocol has potential to lead to substantial cost reduction and resource savings without diminishing patient outcomes.

Assessing Competence of Orthopaedic Residents: The Reliability and Validity of an Objective Structured Clinical Examination After a Sports Medicine Rotation

The traditional method of orthopaedic training in Canada utilizes a time-based system, combined with a formal exit examination. Increasing interest in competency-based curriculum has raised the issue of how to test in-training competence. Currently, the most commonly used method is the In-Training Evaluation Report (ITER), which is known to be relatively subjective in nature; the true establishment of competence would likely benefit from the addition of an objective assessment1,2. The definition of competence varies, but relates to an individual’s ability to perform in the workplace to the required standard3. In surgery, competence is required in many areas, including surgical skill and clinical decision-making. Currently, orthopaedics is lacking a reproducible, objective measurement of resident competence. Objective Structured Clinical Examinations (OSCEs) are an important aspect of certifying examinations in many countries. First developed in the late 1970s, an OSCE consists of multiple, timed stations at which each candidate is faced with a discrete patient or case-based clinical task and is evaluated in an objective and structured way; both the task and the assessment are standardized4-6. An OSCE is especially suited to testing aspects of the role of medical expert4,7,8. To our knowledge, there is very little published literature on the validity and reliability of OSCEs in orthopaedics. Recently, Beran et al. used an OSCE to assess history-taking and physical examination skills of orthopaedic residents, which served to highlight deficiencies in resident knowledge9. The ability to formulate valid and reliable in-training OSCEs may become an essential tool in competency-based orthopaedic training and may be used to assess resident competence regularly throughout training, to identify residents with knowledge deficits compared with their peers, and to allow appropriate remediation. A compulsory module at our university is a …

Repetitive activity alters perfusion of proximal interphalangeal joints of the human hand.

ObjectiveTo examine whether competitive volleyball players show any difference in perfusion of their proximal interphalangeal (PIP) joints compared with a healthy group of subjects. Also to assess the viability of a dual wavelength laser Doppler imager (LDI) in making these measurements. SettingPhysiology laboratory. ParticipantsTen active volleyball players who had experienced repetitive finger joint injury and 12 age- and sex-matched normal control subjects. Main Outcome MeasuresUsing a modified LDI incorporating a near- infrared (850 nm) laser as well as a standard red (633 nm) laser, scans were performed over the dorsum of the hands of the volleyball players and the control group. ResultsHigher perfusion values were obtained with the 850-nm laser than with the red 633-nm laser. When referenced to adjacent skin blood flow, perfusion over PIP joints of volleyball players was found to be significantly higher than that in control subjects (p = 0.00012; n = 10–12). ConclusionsThe higher perfusion values obtained using the 850-nm laser suggest that the longer wavelength laser is measuring perfusion in a greater volume of tissue, which could include subcutaneous structures. Volleyball players have significantly higher perfusion over the PIP joints, which is unlikely to be due to differences in skin perfusion over the two regions but is more likely to be related to hyperemia of the underlying PIP joints. The reason for increased PIP perfusion is not clear; it may represent ongoing tissue inflammation due to repeated injury, or it could be an adaptive response to the stresses placed on these joints by this type of repetitive activity. Clinical RelevanceNear-infrared laser Doppler imaging has the potential to provide a noninvasive clinical assessment of finger joint injuries.

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

➤ 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.

Spinal surgery fellowship education in Canada: evaluation of trainee and supervisor perspectives on cognitive and procedural competencies.

Study Design. A cross-sectional survey of spine surgery fellowship educators and trainees. Objective. To determine educator and trainee perspectives on the relative importance of core cognitive and procedural competencies in fellowship training. To determine perceptions of confidence in competencies by trainees near the end of their fellowship. Finally, to determine potential differences comparing surgeons by background specialty training (neurosurgical or orthopedic) of their views on competencies. Summary of Background Data. Spine surgery is a growing subspecialty with increasing collaboration among specialists of varied specialty backgrounds involved in education. With the recent implementation of competency-based curricula during specialty training, opportunities may exist in enhancing fellowship education. Methods. A questionnaire on cognitive and procedural competencies was administered (online and paper) to fellowship educators and trainees across Canada. A follow-up questionnaire was administered to nonresponders 3 months later. Survey results were summarized using qualitative and descriptive statistics with comparative analyses performed. Results. Of the identified respondents, the response rate was 91%, (15/17 fellow trainees; 47/51 educators). Twelve of the 13 core cognitive skill categories were rated as being important to acquire by the end of fellowship. Trainees were not comfortable performing, and requested additional training in 8 of the 29 less common and technically demanding procedural skills. There were different perceptions on the relative importance of competencies comparing trainees by specialty background as well as different perceptions on the types of competencies where additional training was desired to achieve competency (P < 0.05). Fellowship educators and trainees possessed similar perceptions on the relative importance of core cognitive and procedural competencies required for successful training. Conclusion. Background specialty influenced the perceptions of both fellowship educators and trainees. This study identified potential gaps or perceived deficiencies in the competency of current fellows. Improvements in spine fellowship education should target these areas through developing evidence-based curriculum changes.

Development of a Workshop on “Optimizing Learning in Orthopaedic Surgery”

Objective: The objective of this study was to conduct needs assessment, develop and evaluate a workshop template pertaining to the “optimizing learning during orthopaedic residency training”. Methods: A needs assessment with a composite group of residents was completed. Based on the needs assessment specific objectives to be completed by the end of an interactive workshop were identified. Worksheets from each group session were collected from the participants to create a summary of discussion sessions. We used thematic analysis to analyze the discussion session. A standard evaluation tool was used to evaluate the workshop. Setting: The largest accredited academic institution for orthopaedic surgery within North America. Participants: All PGY1 through to PGY4 residents were invited to participate in the workshop and its evaluation. A total of 44 residents participated in the workshop discussions and 39 residents evaluated the workshop. Results: A workshop was developed based on the needs assessment. Schedule was outlined consisting of small group discussions followed by a plenary session after each main domain. Summary of discussion sessions was the main deliverable from this interactive orthopaedic resident workshop. Three main themes emerged from the summary of discussion sessions to be of critical importance to optimize learning during orthopaedic residency: 1) residents’ interaction with other residents and health care providers, 2) resources available to residents clinically and academically and, 3) time management including clinical, academic and life management skills. Conclusions: The summary of discussion sessions is an important document that may assist residents, even those who did not attend the workshop, to optimize learning during orthopaedic residency. Future studies need to evaluate the impact of the workshop on “optimizing learning during an orthopaedic residency training”.

188 – SPINE SURGERY CORE CURRICULUM: A REVIEW OF COMPETENCIES IN SUBSPECIALTY FELLOWSHIP TRAINING

Purpose: To evaluate fellowship trainee and supervisor perceptions on the relative importance of core cognitive and procedural competencies in spine subspecialty fellowship training. Method: A questionnaire was designed through synthesis and amalgamation of two previous surveys designed by other authors. This questionnaire was reviewed for content by spine surgery experts (Canadian Spine Society Education Committee). The questionnaire was administered (online and paper) to fellow trainees and supervisors across Canada and data was collected over a 3-month period. It consisted of 40 MCQ items grouped into 13 broad cognitive skills categories, as well as 29 technical/procedural items. Data was analyzed using qualitative and descriptive statistics (e.g. average mean scores, standard deviations, t-tests). Results: The response rate was 91%, with 15 of 17 fellow trainees and 47 of 51 supervisors completing the survey. Twelve of the 13 core cognitive skill categories were rated as being important to acquire by the end of fellowship. Trainees were not comfortable performing, and requested additional training in 8 of 29 spine surgery technical skill items. Specifically, additional training was believed to be required for intradural procedures (e.g. syringomyelia, intradural neoplasms) and other less common, technically demanding, procedures (e.g. transoral odontoidectomy, anterior thoracic discectomy). Significant differences (p Conclusion: This study demonstrates that fellowship trainees and supervisors have similar perceptions on the relative importance of specific core cognitive and procedural competencies required in achieving successful spine fellowship training. Furthermore, background specialty training (orthopaedic or neurosurgical) influences the perceptions of both fellow trainees and supervisors regarding the importance of specific cognitive and technical skills deemed necessary for successful training.