A Basic Surgical Skills
Curriculum for PGY1 Training
Our 2012 experience
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
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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
• Modules
Soft 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
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Simple
Mattresses
Inverted dermals
Subcuticular
• Knot tying
Power tool operation
• Introduction to:
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Stryker cordless
K-wire driver/collets
Drill chuck
Quick release chuck
Oscillating saw
Basic bone handling
• K-wire and oscillating saw skills
• 10-cc syringe
Numbers as targets
Transverse wire placement
Oblique wire placement
Sawbones humerus
Saw 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
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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