Abstract:
BACKGROUND:An entrustable professional activity describes a professional task that postgraduate residents must master during their training. The use of simulation to assess performance of entrustable professional activities requires further investigation. QUESTIONS/PURPOSES:(1) Is simulation-based assessment of resident performance of entrustable professional activities reliable? (2) Is there evidence of important differences between Postgraduate Year (PGY)-1 and PGY-4 residents when performing simulated entrustable professional activities? METHODS:Three entrustable professional activities were chosen from a list of competencies: management of the patient for total knee arthroplasty (TKA); management of the patient with an intertrochanteric hip fracture; and management of the patient with an ankle fracture. Each assessment of entrustable professional activity was 40 minutes long with three components: preoperative management of a patient (history-taking, examination, image interpretation); performance of a technical procedure on a sawbones model; and postoperative management of a patient (postoperative orders, management of complications). Residents were assessed by six faculty members who used checklists based on a modified Delphi technique, an overall global rating scale as well as a previously validated global rating scale for the technical procedure component of each activity. Nine PGY-1 and nine PGY-4 residents participated in our simulated assessment. We assessed reliability by calculating the internal consistency of the mean global rating for each activity as well as the interrater reliability between the faculty assessment and blinded review of videotaped encounters. We sought evidence of a difference in performance between PGY-1 and PGY-4 residents on the overall global rating scale for each station of each entrustable professional activity. RESULTS:The reliability (Cronbach's α) for the hip fracture activity was 0.88, it was 0.89 for the ankle fracture activity, and it was 0.84 for the TKA activity. A strong correlation was seen between blinded observer video review and faculty scores (mean 0.87 [0.07], p < 0.001). For the hip fracture entrustable professional activity, the PGY-4 group had a higher mean global rating scale than the PGY-1 group for preoperative management (3.56 [0.5] versus 2.33 [0.5], p < 0.001), postoperative management (3.67 [0.5] versus 2.22 [0.7], p < 0.001), and technical procedures (3.11 [0.3] versus 3.67 [0.5], p = 0.015). For the TKA activity, the PGY-4 group scored higher for postoperative management (3.5 [0.8] versus 2.67 [0.5], p = 0.016) and technical procedures (3.22 [0.9] versus 2.22 [0.9], p = 0.04) than the PGY-1 group, but no difference for preoperative management with the numbers available (PGY-4, 3.44 [0.7] versus PGY-1 2.89 [0.8], p = 0.14). For the ankle fracture activity, the PGY-4 group scored higher for postoperative management (3.22 [0.8] versus 2.33 [0.7], p = 0.18) and technical procedures (3.22 [1.2] versus 2.0 [0.7], p = 0.018) than the PGY-1 groups, but no difference for preoperative management with the numbers available (PGY-4, 3.22 [0.8] versus PGY-1, 2.78 [0.7], p = 0.23). CONCLUSIONS:The results of our study show that simulated assessment of entrustable professional activities may be used to determine the ability of a resident to perform professional tasks that are critical components of medical training. In this manner, educators can ensure that competent performance of these skills in the simulated setting occurs before actual practice with patients in the clinical setting.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Dwyer T,Wadey V,Archibald D,Kraemer W,Shantz JS,Townley J,Ogilvie-Harris D,Petrera M,Ferguson P,Nousiainen Mdoi
10.1007/s11999-015-4553-xsubject
Has Abstractpub_date
2016-04-01 00:00:00pages
926-34issue
4eissn
0009-921Xissn
1528-1132pii
10.1007/s11999-015-4553-xjournal_volume
474pub_type
杂志文章abstract::Femoral impaction allografting has been done with and without variations of the original description. The purpose of this study was to review Harris hip scores, radiographs, and complications in patients in whom we used the original technique without significant modifications. Preoperative and postoperative hip scores...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章
doi:10.1097/01.blo.0000150320.73465.82
更新日期:2005-03-01 00:00:00
abstract::A test for knee posterolateral instability, which is a modification of the standard posterolateral rotatory instability test, is described. In this test, the patient lies supine on the examination table with hips and knees flexed to 90 degrees. The examiner grasps both feet and attempts to maximally externally rotate ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-03-01 00:00:00
abstract::Spinal canal stenosis is diagnosed in a 45-year-old man who has osteopoikilosis and anomalies of the hip. Clinical investigations demonstrated a lumbar syndrome, previously described as an early phase of a neuropathic condition, namely, the premyelopathic syndrome. Roentgenographic calculations of canal diameters and ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-06-01 00:00:00
abstract::This biographical sketch on Themistocles Gluck corresponds to the historic text, The Classic: Report on the positive results obtained by the modern surgical experiment regarding the suture and replacement of defects of superior tissue, as well as the utilization of re-absorbable and living tamponade in surgery (1891),...
journal_title:Clinical orthopaedics and related research
pub_type: 传,历史文章
doi:10.1007/s11999-011-1836-8
更新日期:2011-06-01 00:00:00
abstract::A large, well-encapsulated intraneural lipoma occurred within the sciatic nerve of a 34-year-old woman. In a review of the literature, significant differences were noted between the well-encapsulated and the diffusely infiltrative lipofibromatous hamartoma types of intraneural lipomas. The average age at the time of a...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::Sixty-four total articular replacement arthroplasties were performed in 60 patients with an average follow-up period of 24 months. Ninety-three percent of the patients had little or no pain at the time of follow-up examination; 83% of the patients were able to walk unlimited distances; 97% of the patients had a postop...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1984-05-01 00:00:00
abstract:BACKGROUND:In a previous study, we described the distribution of coronal alignment in a normal asymptomatic population and recognized the occurrence of constitutional varus in one of four individuals. It is important to further investigate the influence of this condition on the joint line orientation and how the latter...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-2898-6
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:The notion that neutral alignment is mandatory to assure long-term durability after TKA has been based mostly on short-film studies. However, this is challenged by recent long-film studies. QUESTIONS/PURPOSES:We conducted this long-film study to know (1) whether the risk of aseptic revision for nontraumatic...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999.0000000000000012
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:The Total Knee Arthroplasty (TKA) Complications Workgroup of the Knee Society developed a standardized list and definitions of complications associated with TKA. Twenty-two complications and adverse events believed important for reporting outcomes of TKA were identified. The Editorial Board of Clinical Ortho...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-2980-0
更新日期:2014-01-01 00:00:00
abstract::Segmentation and intramedullary rod fixation of the tibia have been found to be safe and effective procedures in osteogenesis imperfecta. An extensible rod is more difficult to insert than a solid rod due to the problem of obtaining an adequate fit distally, so the practical advantage of one type over the other is not...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-09-01 00:00:00
abstract::Hip osteoarthritis is a common cause of musculoskeletal pain in older adults and may result in decreased mobility and quality of life. Although the presentation of hip osteoarthritis varies, surgical management is required when the disease is severe, longstanding, and unresponsive to nonoperative treatments. For stake...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-008-0625-5
更新日期:2009-03-01 00:00:00
abstract::A review of CT-based orthopaedic navigation is presented with a specific emphasis on arthroplasty for the hip and the knee. Fundamental issues about the laboratory and clinical validation of the applications are addressed. The ability to compute the position and orientation of an acetabular implant using a postoperati...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000126866.29933.42
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:High-dose-rate brachytherapy (HDR-BT) and external-beam radiation therapy (EBRT) are two modalities used in the treatment of soft tissue sarcoma. Previous work at our institution showed early complications and outcomes for patients treated with HDR-BT, EBRT, or a combination of both radiation therapy modalit...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999.0000000000000079
更新日期:2018-03-01 00:00:00
abstract::The erythrocyte sedimentation rate (ESR) was analyzed in 176 patients treated with cemented total hip arthroplasty (THA) for primary osteoarthritis and correlated with the degree of heterotopic bone formation (HBF) one year after the THA. Ninety patients were treated with indomethacin in the first six postoperative we...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1989-11-01 00:00:00
abstract::The age- and sex-specific incidence of hip fractures is central Norway is reported for the periods of 1972-1973 and 1983-1984. The incidence of hip fracture for women had increased by approximately 22% in the intervening period. The region under investigation was subdivided into urban, semirural, and rural areas. The ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-05-01 00:00:00
abstract::Rheumatoid arthritis frequently involves the hindfoot. It may produce a proliferative synovial hypertrophy around the tendons and a gradual destruction of the joints. Unfortunately, this part of the foot frequently is overlooked when caring for these patients who often have multiple areas of involvement giving pain an...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199707000-00009
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Bone cancer pain is very common, and patients with this type of pain may be difficult to treat. Development of an experimental model for studying this condition is critical to advancing an understanding of the mechanisms that cause pain in patients with malignant disease. METHODS:A murine model of bone canc...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000093059.96273.56
更新日期:2003-10-01 00:00:00
abstract::A posterior cruciate ligament avulsion fracture (PCLAF) of the knee can be repaired through a large approach. A new technique based on internal fixation under arthroscopic control employed a posterolateral puncture. The fracture was reduced and the osseous fragment transfixed using a new forceps guide. The osseous fra...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-12-01 00:00:00
abstract::A consecutive series of 125 hybrid total hip arthroplasties were performed in 120 patients by a single surgeon and were observed for an average of 8.6 years (range, 7-11 years). There were 38 men and 82 women with an average age of 71 years (range, 25-87 years) at the time of surgery. The diagnoses included primary an...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1996-12-01 00:00:00
abstract::A light and electron microscopy investigation was performed on a Leeds-Keio ligament removed because of rupture 18 months after implantation to repair an anterior cruciate ligament. The investigation showed fibrous connective tissue on the plane of the main stress force. There was elastin and adequate vascularization ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-06-01 00:00:00
abstract:UNLABELLED:Because of improvements in surgical technique, anesthesia, and rehabilitation, mortality after hip arthroplasty may be on the decline. The purpose of this study was to determine the 90-day mortality rate after uncemented total hip arthroplasty (THA) performed under regional anesthesia. We retrospectively rev...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0528-5
更新日期:2009-01-01 00:00:00
abstract:UNLABELLED:bTwo-staged exchange with delayed reimplantation of a new prosthesis is considered by many to be the preferred method of treatment for deep periprosthetic infection after total hip arthroplasty. Until recently, most authors of previously published reports of this two-staged exchange procedure have used cemen...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000194312.97098.0a
更新日期:2005-12-01 00:00:00
abstract::Design of a synthetic replacement or selection of a biologic substitute requires detailed knowledge of the mechanical properties of the normal ligament. Femur-anterior cruciate ligament-tibia unit (ACL) data have been frequently used for this purpose, although not always properly. Mechanical properties of the human AC...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1985-06-01 00:00:00
abstract::To combat the most common and most serious cause of mechanical failure of total hip arthroplastics, namely loosening, a method of improving the insertion of methacrylate is presented, called the cement fixation system. Using the cement gun with the keying hole seal, the methacrylate is pressure injected into the keyin...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-04-01 00:00:00
abstract::Equinus foot disorder is a common problem for patients with cerebral palsy who are able to ambulate. Botulinum toxin A is a recommended method of treatment for temporary reduction of muscle tone. The efficacy of repeated botulinum toxin A injections in the calf muscles was evaluated in a clinical trial involving 21 ch...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章
doi:10.1097/00003086-200201000-00021
更新日期:2002-01-01 00:00:00
abstract::The indication for otherwise established lateral plate fixation in fractures of the calcaneus becomes relative when severe comminution (Sander's Type III and IV) of the bone involves concomitant massive soft-tissue swelling. The calcaneus is shortened, Böhler's angle flattened, and lateral bulging and varus deformity ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-05-01 00:00:00
abstract::Plugs of cartilage and subchondral bone from patellae were subjected to cyclic compression consisting of rapid ramp loading for 0.3 seconds followed by a 2.7 second pause. At 1000 psi cyclic load, surface abrasion of the cartilage was noted at 250 cycles of compression. Primary fissures, which penetrated to the calcif...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-04-01 00:00:00
abstract::Bone-acrylic interface pressure measurements were recorded at the medial interior rasped surfaces of fresh cadaver femurs during digital packing of acrylic bone cement and during insertion and seating of a Trapezoidal-28 femoral total hip component. Plugging of the femoral canal below the tip of the prosthesis stem wa...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1976-11-01 00:00:00
abstract:BACKGROUND:Kidney dysfunction (KD) after hip fracture surgery is a major complication. However, the incidence and risk factors of KD in this population are unclear. QUESTIONS/PURPOSES:We therefore (1) determined the incidence of KD in a large cohort of fracture patients, (2) identified preoperative risk factors predis...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-3098-0
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documenta...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-012-2719-3
更新日期:2013-06-01 00:00:00