Our 2012 experience A Basic Surgical Skills Curriculum for PGY1 Training M. Daniel Wongworawat, MD Professor and Program Director Loma Linda University.

Our 2012 experience

A Basic Surgical Skills Curriculum for PGY1 Training

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

•ModulesSoft 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 syringeNumbers as targets

Transverse wire placement

Oblique wire placement

Sawbones humerusSaw 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