Thanks, Dr. Joyner. Good afternoon. My name is Alan Shamrock. I'm a second year resident at the University of Iowa. It truly is a pleasure to be here. Today I will be discussing trends in shoulder and knee arthroscopy volume among orthopedic surgery residents. I'd like to thank my co-authors for their contributions to this study, for which we have no disclosures. Arthroscopy volume in the United States has increased significantly in the past 15 years. As volume increases, resident and fellow exposure to arthroscopy becomes more and more important. Additionally, arthroscopy is a technically demanding procedure with a significant learning curve. Recent studies have suggested that 50 arthroscopic cases may be necessary for developing the technical skill to be competent in diagnostic shoulder arthroscopy, while the threshold for mastery may be more than 475 arthroscopic cases. Cannon and colleagues demonstrated a marked improvement in task performance on an arthroscopic simulator in more experienced senior residents, however resident exposure with arthroscopy is known to be widely variable. The purpose of this study was to evaluate trends in current surgical volume of shoulder and knee arthroscopy in United States residency programs. This was accomplished by a retrospective review of case log data from the ACGME. Within the ACGME database, residents are responsible for logging their own cases. Case logs are monitored by residency program coordinators for both consistency and accuracy. We reviewed a decade-long study period from 2007 to 2017, notably the ACGME implemented case minimum requirements for shoulder and knee arthroscopy in 2013. The benchmarks of 20 shoulder arthroscopies and 30 knee arthroscopies must be met before a resident is allowed to graduate. Segmental regression analysis of shoulder arthroscopy case logs demonstrated a significant increase in the median number of cases logged over the entirety of residency training from 80 in 2007 to 117 in 2013. From 2013 to 2014, there was a significant decrease in cases logged from 117 cases to 60 cases. Numbers of cases logged in 2014 to 2017 remain low relative to the 2007-2013 period with a median of 67 cases in 2017. Similarly, there is a significant increase in the median number of knee arthroscopy cases logged from 2007 to 2013, increasing from 156 cases to 170 cases. A sharp decline in the number of cases logged was also seen for knee arthroscopy from 170 cases in 2013 to 112 cases in 2014. Similar to shoulder arthroscopy, knee arthroscopy case log numbers in 2014 to 2017 remain low relative to the 2007-2017 period with a median of 105 cases in 2017. Shoulder and knee arthroscopy case logs accounted for 94.7% of the total number of arthroscopy cases logged over the study period. The median total number of arthroscopic cases logged by graduating residents followed a similar trend with a decrease from 301 cases in 2013 to 186 in 2017. Importantly, the volume of total surgical cases did not change significantly over the study period. The majority of the decline in case log volume occurred after 2013 when the ACGME implemented minimum volume requirements for a select group of surgical cases, including knee and shoulder arthroscopy. We also observed a decline in the number of all arthroscopic case logs by residents over the study period. In large part, this decline coincides with the implementation of required case minimums. We don't know whether this decline is secondary to residents ceasing to log their cases after meeting the minimum or if they are pursuing other non-arthroscopic cases or both. The consistent total surgical volume over the study period suggests that it may mean more of the latter scenario, but further studies are needed. In conclusion, orthopedic resident case logs for knee and shoulder arthroscopy demonstrated a sharp decline coinciding with the implementation of ACGME benchmark minimums. Moreover, the median number of total arthroscopic procedures has declined to the point where the average graduate may not be able to perform complex arthroscopic tasks based on previously published benchmark minimums. Further prospective studies are warranted to determine how minimum case requirements may impact arthroscopy skill education throughout residency. Thank you.

video presentation

Alan Shamrock

shoulder arthroscopy

knee arthroscopy

orthopedic surgery residents