Variability in Foot and Ankle Case Volume in Orthopaedic Residency Training

2017 ◽  
Vol 10 (6) ◽  
pp. 531-537 ◽  
Author(s):  
Steven F. DeFroda ◽  
Joseph A. Gil ◽  
Brad D. Blankenhorn ◽  
Alan H. Daniels
Keyword(s):  
Orthopaedic Surgery ◽  
Rapid Development ◽  
Foot And Ankle ◽  
Case Volume ◽  
New Techniques ◽  
Surgical Residency ◽  
Surgical Case ◽  
Orthopaedic Residency ◽  
Case Logs ◽  
Ankle And Foot

Surgical case volume during orthopaedic surgical residency is a concern among trainees and program directors alike. With an ongoing trend toward further subspecialization and the rapid development of new techniques and devices, the breadth of procedures that residents are exposed to continues to increase. Accreditation Council for Graduate Medical Education surgical case logs from 2009 to 2013 for graduating orthopaedic surgery residents were examined to assess the national averages of orthopaedic procedures logged by graduating orthopaedic surgery residents in the leg/ankle and foot/toes categories. This investigation revealed that there was an 8% increase in the total number of leg/ankle cases and 12% increase in foot/toes cases performed by graduating orthopaedic surgery residents, which has not significantly increased from 2009 to 2013. Across years examined in this study, significant variability existed between the 10th and 90th percentiles for total foot and ankle resident case exposure (P < .05), particularly within ankle arthroscopy, where there was a 15-fold difference in the number of arthroscopy cases performed by residents in the 90th percentile compared with the 10th percentile. The overall volume of foot and ankle cases performed by graduating orthopaedic surgery residents has increased despite not being statistically significantly from 2009 to 2013. Levels of Evidence: Level III: Cohort study

scholarly journals The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Eric C. Gokcen ◽  
Joshua C. Luginbuhl ◽  
Joshua C. Luginbuhl
Keyword(s):  
Orthopaedic Surgery ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Perceived Effectiveness ◽  
Educational Impact ◽  
Short Term ◽  
Surgical Mission ◽  
Ankle Surgery ◽  
Orthopaedic Residency ◽  
The Impact

Category: Other Introduction/Purpose: Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips. Methods: A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology. Results: When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75. Conclusion: The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.

Do Orthopaedic Resident and Fellow Case Logs Accurately Reflect Surgical Case Volume?

2018 ◽  
Vol 75 (4) ◽  
pp. 1052-1057 ◽  
Author(s):  
Kanu Okike ◽  
Peter Z. Berger ◽  
Carrie Schoonover ◽  
Robert V. O′Toole
Keyword(s):  
Case Volume ◽  
Surgical Case ◽  
Orthopaedic Resident ◽  
Case Logs

scholarly journals Resident Exposure to Peripheral Nerve Surgical Procedures During Residency Training

2016 ◽  
Vol 8 (2) ◽  
pp. 173-179 ◽  
Author(s):  
Joseph A Gil ◽  
Alan H Daniels ◽  
Edward Akelman
Keyword(s):  
Peripheral Nerve ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
General Surgery ◽  
Orthopaedic Surgery ◽  
Case Volume ◽  
Peripheral Nerve Surgery ◽  
Case Logs ◽  
Nerve Surgery ◽  
Neurological Surgery

ABSTRACT  Variability in case exposures has been identified for orthopaedic surgery residents. It is not known if this variability exists for peripheral nerve procedures.Background  The objective of this study was to assess ACGME case log data for graduating orthopaedic surgery, plastic surgery, general surgery, and neurological surgery residents for peripheral nerve surgical procedures and to evaluate intraspecialty and interspecialty variability in case volume.Objective  Surgical case logs from 2009 to 2014 for the 4 specialties were compared for peripheral nerve surgery experience. Peripheral nerve case volume between specialties was performed utilizing a paired t test, 95% confidence intervals were calculated, and linear regression was calculated to assess the trends.Methods  The average number of peripheral nerve procedures performed per graduating resident was 54.2 for orthopaedic surgery residents, 62.8 for independent plastic surgery residents, 84.6 for integrated plastic surgery residents, 22.4 for neurological surgery residents, and 0.4 for surgery residents. Intraspecialty comparison of the 10th and 90th percentile peripheral nerve case volume in 2012 revealed remarkable variability in training. There was a 3.9-fold difference within orthopaedic surgery, a 5.0-fold difference within independent plastic surgery residents, an 8.8-fold difference for residents from integrated plastic surgery programs, and a 7.0-fold difference within the neurological surgery group.Results  There is interspecialty and intraspecialty variability in peripheral nerve surgery volume for orthopaedic, plastic, neurological, and general surgery residents. Caseload is not the sole determinant of training quality as mentorship, didactics, case breadth, and complexity play an important role in training.Conclusions

scholarly journals National Trends in Carpal Tunnel Release and Hand Fracture Procedures Performed During Orthopaedic Residency: An Analysis of ACGME Case Logs

2016 ◽  
Vol 8 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Richard M. Hinds ◽  
Michael B. Gottschalk ◽  
John T. Capo
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Temporal Trends ◽  
Fracture Dislocation ◽  
Annual Data ◽  
Case Volume ◽  
Hand Fracture ◽  
The Mean ◽  
Orthopaedic Residency ◽  
Case Logs

ABSTRACT Background  Mastery in performing carpal tunnel release (CTR) and hand fracture procedures is an essential component of orthopaedic residency training. Objective  To assess orthopaedic resident case log data for temporal trends in CTR and hand fracture cases and to determine the degree of variability in case volume among residents. Methods  Accreditation Council for Graduate Medical Education orthopaedic surgery resident case logs were reviewed for graduation years 2007 through 2014. Annual data regarding the mean number of CTR and hand fracture/dislocation procedures were recorded, as well as the median number of procedures reported by the top and bottom 10% of residents (by case volume). Temporal trends were assessed using linear regression modeling. Results  There was no change in the mean number of CTRs performed per resident. Over the 8-year period, the top 10% of residents performed a significantly greater number of CTRs than the bottom 10% (62.1 versus 9.3, P &lt; .001). Similarly, no change was noted in the mean number of total hand fracture/dislocation cases performed, with the top 10% of residents performing significantly more hand fracture cases than the bottom 10% (47.1 versus 9.3, P &lt; .001). Conclusions  Our results indicate no change in CTR and hand fracture caseload for orthopaedic residents. However, as resident experience performing both procedures varies significantly, this variability likely has important educational implications.

Variability in Surgical Case Volume of Orthopaedic Surgery Residents

2016 ◽  
Vol 24 (3) ◽  
pp. 207-212 ◽  
Author(s):  
Joseph A. Gil ◽  
Alan H. Daniels ◽  
Arnold-Peter C. Weiss
Keyword(s):  
Orthopaedic Surgery ◽  
Case Volume ◽  
Surgical Case

scholarly journals MP35-17 DESCRIBING UROLOGY RESIDENCY SURGICAL CASE VOLUME OVER TIME: A REVIEW OF THE ACGME RESIDENT CASE LOGS

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Jonathan Wingate* ◽  
Byron Joyner ◽  
Judith Hagedorn ◽  
Niels Johnsen
Keyword(s):  
Case Volume ◽  
Surgical Case ◽  
Case Logs ◽  
Over Time ◽  
Urology Residency

Excess Opioid Disposal Following Orthopaedic Surgery: A Randomized Clinical Trial

2020 ◽  
pp. 193864002098092
Author(s):  
Cornelia Keyser ◽  
Abhiram Bhashyam ◽  
Abdurrahman Abdurrob ◽  
Jeremy T. Smith ◽  
Eric Bluman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Orthopaedic Surgery ◽  
Control Group ◽  
Foot And Ankle ◽  
Opioid Medication ◽  
Ankle Surgery ◽  
Randomized Control ◽  
Level I ◽  
To Receive ◽  
Experimental Group

Background Previous research indicates low disposal rates of excess postoperative narcotics, leaving them available for diversion or abuse. This study examined the effect of introducing a portable disposal device on excess opiate opioid disposal rates after lower extremity orthopaedic surgery. Methods This was a single site randomized control trial within an outpatient orthopaedic clinic. All patients 18 years or older, undergoing outpatient foot and ankle surgery between December 1, 2017 and August 1, 2018 were eligible. Patients were prospectively enrolled and randomized to receive standard opioid disposal instructions or a drug deactivation device at 2-week postoperative appointments. Participants completed an anonymous survey at 6-week postoperative appointments. Results Of the 75 patients surveyed, 68% (n = 26) of the experimental group and 56% (n = 21) of the control group had unused opioid medication. Of these, 84.6% of patients who were given Deterra Drug Deactivation System deactivation pouches safely disposed of excess medication, compared with 38% of controls (P = .003). When asked if they would use a disposal device for excess medication in the future, 97.4% (n = 37) of the experimental and 83.8% (n = 31) of the control group reported that they would. Conclusions Providing a portable disposal device with postoperative narcotic prescriptions may increase safe disposal rates of excess opioid medication following lower extremity orthopaedic surgery. Levels of Evidence Level I

scholarly journals The effect of surgical case volume on outcome after the Norwood procedure

2005 ◽  
Vol 129 (4) ◽  
pp. 754-759 ◽  
Author(s):  
Paul A. Checchia ◽  
Jamie McCollegan ◽  
Noha Daher ◽  
Nikoleta Kolovos ◽  
Fiona Levy ◽  
...  
Keyword(s):  
Norwood Procedure ◽  
Case Volume ◽  
Surgical Case

scholarly journals Medical Malpractice Trends in Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Rishin J. Kadakia ◽  
Keith Orland ◽  
Akhil Sharma ◽  
Jie Chen ◽  
Craig C. Akoh ◽  
...  
Keyword(s):  
Medical Malpractice ◽  
Orthopaedic Surgery ◽  
Nonoperative Treatment ◽  
Anatomical Location ◽  
Foot And Ankle ◽  
Common Complication ◽  
Adult Females ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
Malpractice Claims

Category: Other Introduction/Purpose: Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopaedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. Methods: The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Results: Forty nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). Conclusion: This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.

The Safety of the Esmarch Tourniquet

Foot & Ankle ◽  
1993 ◽  
Vol 14 (5) ◽  
pp. 278-283 ◽  
Author(s):  
William C. Biehl ◽  
James M. Morgan ◽  
F. William Wagner ◽  
Rodney A. Gabriel
Keyword(s):  
Learning Curve ◽  
Clinical Application ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Surgical Case ◽  
Significant Difference ◽  
Mean Pressure ◽  
Continued Use

The use of an Esmarch bandage as a tourniquet in surgery has been criticized. Many authors claim that the pressures under the Esmarch are inconsistent and may be extremely high. We have seen few, if any, problems from the use of an Esmarch in surgery of the foot and ankle. The purpose of this study was to evaluate the pressures generated under the Esmarch tourniquet in a situation that mimics its clinical application, and to determine whether pressures of appropriate magnitude and consistency are obtained in order to recommend its continued use in surgery. Ten volunteers performed numerous applications of the Esmarch. The number of wraps and the width of the Esmarch bandage used were varied. The Esmarch was applied as it would be for a surgical case. Pressures directly beneath the Esmarch were recorded 8 cm proximal to the distal tip of the medial malleolus. Considering all volunteers and all pressures generated, a 3-in Esmarch applied with three wraps gave a mean pressure (±SD) of 225 ± 46 mm Hg. A 3-in Esmarch applied with four wraps gave a mean pressure of 291 ± 53 mm Hg. A 4-in Esmarch applied with three wraps gave a mean pressure of 233 ± 35 mm Hg, and a 4-in Esmarch with four wraps gave a mean pressure of 284 ± 42 mm Hg. The maximum pressures generated by any individual were as follows: 3-in three wraps, 321 mm Hg; 3-in four wraps, 413 mm Hg; 4-in three wraps, 328 mm Hg; and 4-in four wraps, 380 mm Hg. There was no significant difference in the magnitude or consistency of pressures generated between the experienced and inexperienced wrappers. There did not appear to be a learning curve for the application of the Esmarch bandage. We conclude that an Esmarch bandage, used as a tourniquet, can generate safe and reliable pressures. Either a 3-in or 4-in Esmarch bandage applied above the ankle with three circumferential overlapping wraps consistently results in pressures that are in a safe range.

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