A study of attributable variables impacting orthopedic trauma surgical training

Abstract

Purpose: In medical colleges, resident training programs must provide adequate surgical experiences, making them qualified at the end of residency program. It is generally believed that it would take more time for a surgical resident to perform surgical procedures than a board-certified surgeon. There is no current benchmark with regards to operative time and surgical cases involving orthopedic surgery residents. In this study, we focused on two key aspects of surgical training variables, namely, surgical duration & C-arm shoots when the procedure is done by a faculty surgeon in comparison to done by an orthopedic resident under supervision of faculty surgeon.

Methods: It is an observational prospective study, we observed patients undergoing 1 of 5 common orthopedic trauma operations in a community teaching hospital. We recorded two variables, 'skin to skin' surgical duration & number of image intensifier television/C-arm shoots of faculty surgeons and orthopedic resident (postgraduate-3yr) under supervision of faculty surgeon. We calculated mean difference of two variables with or without resident & determined statistical significance, we also compared functional outcome at final follow-up.

Results: The total number of procedure observed was 402. On observing summarized results of all surgical procedures, faculty surgeons took on an average 33 min lesser (p < 0.05) & on an average 37 lesser number of shoots (p < 0.05) than resident surgeons. The difference in surgical duration tended to increase with the greater complexity of the surgical dissection. The difference in number of C-arm shoots tended to increase with the increase in surgical duration in closed procedures. In all the five procedures there was no significant difference (p > 0.05) in functional outcome of cases performed by faulty surgeon and resident.

Conclusion: Little data has been previously published regarding the impact of teaching orthopedic resident in operating room. We demonstrate that resident participation increases the procedure time for commonly performed orthopedic procedures and also the number of C-arm shoots, hence there is a need for technical training facilities outside the operating room such as in cadaveric labs, saw bone labs & virtual surgery simulation. Also the preoperative plan should be thoroughly discussed by faculty surgeon with residents.

Keywords: Orthopedics; Resident training; Surgical procedures; Surgical training.