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Elbow and Wrist Arthroscopy Case Volume Is Declining Among Graduating Orthopedic Surgery Residents
Michael Otten, MD; Maxwell A Northrop, BS; Mary-Katherine Lynch, MD; Charles Daly, MD
Medical University of South Carolina, Charleston, SC
Purpose: The purpose of this study was to evaluate the exposure of graduating orthopedic surgery residents to elbow and wrist arthroscopy.
Methods: Accreditation Council for Graduate Medical Education (ACGME) case log data was accessed, and arthroscopic procedures involving the elbow and wrist were identified for the graduating classes of 2012-2022. The average number of cases logged per resident was compared to assess procedure volume, and standard deviation and 10th, 30th, 50th, 70th, and 90th percentiles of case volumes were utilized to assess volume variability. No ACGME data for wrist or elbow arthroscopy among plastic surgery residents was available.
Results: The average recorded number of elbow arthroscopic procedures among graduating residents has decreased from 3.2 ± 4 in 2012 (range: 0-41) to 1.9 ± 2 in 2022 (range: 0-17), with the difference in case numbers being statistically different (p<0.001). Likewise, the average number of wrist arthroscopic procedures among graduating residents has decreased from 6.2 ± 6 (range: 0-68) to 3 ± 3 in 2022 (range: 0-25), also with a statistically significant difference (p<0.001). Variability in case numbers was higher in earlier years, with a universal trend toward lower case numbers in recent years (10th-90th percentile wrist arthroscopy: 0-14 in 2012, 0-7 2022).
Conclusions: Despite the continued role of elbow and wrist arthroscopy in upper extremity orthopedic surgery, resident exposure remains limited and has decreased in the past decade. The 2022 graduating class of orthopedic surgery residents performed an average of 1.9 elbow arthroscopies and 3 wrist arthroscopies by graduation.
Discussion: Elbow and wrist arthroscopy has previously been shown to be a highly technical skillset with nontransferable skills from other more commonly performed large joint arthroscopy. Understanding the current limited resident exposure to these cases can help training programs increase the development of these skills with the possible adjunct of cadaver labs or the development of high-validity simulation.
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