Development of a certification examination for orthopedic sports medicine fellows

Background The purpose of this study was to develop a multifaceted examination to assess the competence of fellows following completion of a sports medicine fellowship. Methods Orthopedic sports medicine fellows over 2 academic years were invited to participate in the study. Clinical skills were evaluated with objective structured clinical examinations, multiple-choice question examinations, an in-training evaluation report and a surgical logbook. Fellows' performance of 3 technical procedures was assessed both intraoperatively and on cadavers: anterior cruciate ligament reconstruction (ACLR), arthroscopic rotator cuff repair (RCR) and arthroscopic shoulder Bankart repair. Technical procedural skills were assessed using previously validated task-specific checklists and the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale. Results Over 2 years, 12 fellows were assessed. The Cronbach alpha for the technical assessments was greater than 0.8, and the interrater reliability for the cadaveric assessments was greater than 0.78, indicating satisfactory reliability. When assessed in the operating room, all fellows were determined to have achieved a minimal level of competence in the 3 surgical procedures, with the exception of 1 fellow who was not able achieve competence in ACLR. When their performance on cadaveric specimens was assessed, 2 of 12 (17%) fellows were not able to demonstrate a minimal level of competence in ACLR, 2 of 10 (20%) were not able to demonstrate a minimal level of competence for RCR and 3 of 10 (30%) were not able to demonstrate a minimal level of competence for Bankart repair. Conclusion There was a disparity between fellows' performance in the operating room and their performance in the high-fidelity cadaveric setting, suggesting that technical performance in the operating room may not be the most appropriate measure for assessment of fellows' competence. Contexte Le but de cette etude etait de concevoir un examen a plusieurs volets pour evaluer la competence des moniteurs cliniques a la fin de leur formation en medecine sportive. Methodes Apres leur formation de 2 ans pour devenir orthopedistes en medecine sportive, les moniteurs cliniques ont ete invites a participer a l'etude. Leurs habiletes cliniques ont ete evaluees au moyen d'examens cliniques objectifs structures, de questionnaires a choix multiple, d'un rapport d'evaluation en cours de formation et d'un journal de bord chirurgical. Leur habilete a realiser 3 techniques chirurgicales differentes a ete evaluee au bloc operatoire et sur des cadavres : reconstruction du ligament croise anterieur (RLCA), reparation arthroscopique de la coiffe des rotateurs (RACR) et intervention de Bankart sous endoscopie pour l'epaule. Les habiletes techniques ont ete evaluees au moyen de listes de verification specifiques aux taches validees et au moyen de l'outil d'evaluation globale ASSET (Arthroscopic Surgical Skill Evaluation). Resultats Sur une periode de 2 ans, 12 moniteurs ont ete evalues. Le coefficient alpha de Cronbach pour les evaluations techniques a ete superieur a 0,8, et la fiabilite inter-examinateurs pour l'evaluation des interventions sur des cadavres a ete superieure a 0,78, soit une fiabilite jugee satisfaisante. Lors de l'evaluation au bloc operatoire, on a juge que tous les moniteurs detenaient le niveau minimum de competences pour executer les 3 techniques chirurgicales, a l'exception d'un seul qui n'a pas atteint le niveau de competence pour la RLCA. l'evaluation de leurs competences pour les interventions sur des cadavres, 2 sur 12 (17 %) n'ont pas atteint le niveau minimum de competence pour la RLCA, 2 sur 10 (20 %) pour la RACR et 3 sur 10 (30 %) pour l'intervention de Bankart. Conclusion On a note une disparite dans la competence des moniteurs entre le bloc operatoire et le contexte cadaverique haute fidelite, ce qui donne a penser que le rendement technique au bloc operatoire pourrait ne pas etre le moyen le plus approprie d'evaluer la competence des moniteurs cliniques.