Arthroscopic proficiency: A survey of orthopaedic sports medicine fellowship directors and orthopaedic surgery department chairs

Purpose: The goal of this study was to evaluate the opinion of sports medicine fellowship directors and orthopaedic surgery department chairpersons on how many repetitions the average resident needs to become proficient in several common arthroscopic procedures. Type of Study: A cross-sectional study. Methods: A questionnaire was mailed to all fellowship directors on a list maintained by the American Academy of Orthopaedic Surgeons and to all department chairpersons on a list maintained by the American Medical Association. Respondents were asked to estimate the number of operations needed for a trainee to reach minimal proficiency (able to perform procedure skin-to-skin with supervision) and proficiency (capable of performing procedure without supervision) for 5 common arthroscopic procedures: diagnostic knee scope, partial medial meniscectomy, anterior cruciate ligament (ACL) reconstruction, diagnostic shoulder scope, and subacromial decompression. Results: A total of 164 of 230 (71%) people responded to the questionnaire. Department chairpersons who did not perform arthroscopy consistently estimated two thirds the number of operations that department chairpersons who did perform arthroscopy and nearly half the number of operations estimated by fellowship directors. Chairpersons who did perform arthroscopy had responses more similar to fellowship directors than to department heads who did not perform arthroscopy. Conclusions: These results indicate that, in the opinion of physicians involved in the education of residents and fellows, it may take a substantial number of repetitions to become proficient in arthroscopy. Physicians who perform little or no arthroscopy themselves may underestimate its difficulty. Interestingly, there was substantial variability in the number of repetitions estimated to achieve proficiency in all procedures. The results of this study may be helpful in designing arthroscopic training programs for orthopaedic residents or sports medicine fellows; however, the wide variability in opinions may indicate difficulty in reaching a consensus.