Citations

Background: Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency. Purpose: To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows. Study Design: Case series; Level of evidence, 4. Methods: A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine–accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions. Results: Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement ( P < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement ( P < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship ( P = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship ( P < .001). Conclusion: This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.

Salt sensitivity is a major cardiovascular focus, but extremes of sodium (Na + ) intake can affect subject dropout rates. We analyzed dietary compliance and baseline cardiovascular indices in an ongoing genotype‐phenotype protocol in healthy young adults. Study visits followed 5 day consumption of 3 daily Na + levels: normal (150) low (10) and high (400 mmol/day). Compliance was determined by 24‐hour Na + excretion. Vital signs were obtained on each visit. Of the first 30 subjects to date, one was unable to tolerate the low Na + diet due to palatability. Mean ± SE urine Na + excretion was 113 ± 27, 25 ± 18 and 328 ±110 mmol for normal, low, and high Na + , respectively. Low Na + caused a significant weight change of −1.6 ± 2.2 kg from screen. High Na + diet decreased resting HR (−2.7 bpm) and increased 24hr urine volume 25% from the normal Na + diet. No correlation was found between urine indices and weight change in the subjects. This dietary sodium crossover study is generally well‐tolerated with high compliance. Low Na + diet appears to cause weight loss; high Na + causes an increase in urine volume and decrease in HR, but no effects on weight or blood pressure. HL 089331