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Assessment of Resident Technical Skill with the Use of a Novel Cubital Tunnel Release Technique
Kavita T. Vakharia, MD; Mark D. Hatch, MD; Randy M. Hauck, MD; Kenneth F. Taylor, MD
Penn State Hershey Medical Center, Hershey, PA

Introduction: Current options to surgically treat cubital tunnel syndrome include in situ decompression, medial epicondylectomy, and several varieties of anterior transposition. A minimally-invasive cubital tunnel release using lighted retractors typically used for dissection of the breast and pectoralis muscle in general and plastic surgery has been developed. This project aims to illustrate the ease with which this novel approach can be taught to novice surgeons as well as describing a validated tool for assessment of surgical skill directly relating to a procedure commonly performed by plastic and orthopedic surgeons.
Materials & Methods: Ten plastic surgery and orthopedic surgery residents of varying years participated in this study. The lighted retractor technique that the residents were tested on was presented to them via Powerpoint format fifteen minutes prior to their examination. The resident evaluation was performed by one of our CAQ board-certified hand surgeons and included a detailed checklist of required surgical steps; a global rating scale; timing the procedure; and finally, performing a dissection to assess for complications. Study data was compared between junior and senior residents as well as a rho correlation analysis was performed to verify the validity of the assessment tools.
Results: Ten residents participated in the study. Validation measurements showed strong correlations between the pass/fail grade and the detailed checklist (r=0.8) and the global rating scale (r=0.6). Training year was most strongly correlated with the global rating scale (r=0.8) and there was a trend towards faster surgical time in the senior resident cohort. All residents completed a survey describing their prior experience with the procedure showing all senior residents had prior experience with this procedure however only two had previously performed the lighted retractor technique. All residents found the examination to be useful for their education.
Conclusion: This study demonstrated that surgical residents learned this novel cubital tunnel release technique and immediately performed the procedure in an examination setting with ease. This study also highlighted the importance of simulated clinical assessments to the advancement of a residentís education. While multiple choice examinations are a well-validated measure of assessing clinical knowledge, surgical residents have the added component of learning technical skill during their training. Furthermore, all residents favored including this and similar technical skill assessments in their curriculum to ensure they obtain targeted areas of improvement required for them to be well prepared for their practice after completion of their training program.


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