Arthroscopic proficiency: methods in evaluating competency

BackgroundThe current paradigm of arthroscopic training lacks objective evaluation oftechnical ability and its adequacy is concerning given the acceleratingcomplexity of the field. To combat insufficiencies, emphasis is shiftingtowards skill acquisition outside the operating room and sophisticatedassessment tools. We reviewed (1) the validity of cadaver and surgicalsimulation in arthroscopic training, (2) the role of psychomotor analysisand arthroscopic technical ability, (3) what validated assessment tools areavailable to evaluate technical competency, and (4) the quantification ofarthroscopic proficiency.MethodsThe Medline and Embase databases were searched for published articles in theEnglish literature pertaining to arthroscopic competence, arthroscopicassessment and evaluation and objective measures of arthroscopic technicalskill. Abstracts were independently evaluated and exclusion criteriaincluded articles outside the scope of knee and shoulder arthroscopy as wellas original articles about specific therapies, outcomes and diagnosesleaving 52 articles citied in this review.ResultsSimulated arthroscopic environments exhibit high levels of internal validityand consistency for simple arthroscopic tasks, however the ability totransfer complex skills to the operating room has not yet been established.Instrument and force trajectory data can discriminate between technicalability for basic arthroscopic parameters and may serve as useful adjunctsto more comprehensive techniques. There is a need for arthroscopicassessment tools for standardized evaluation and objective feedback oftechnical skills, yet few comprehensive instruments exist, especially forthe shoulder. Opinion on the required arthroscopic experience to obtainproficiency remains guarded and few governing bodies specify absolutequantities.ConclusionsFurther validation is required to demonstrate the transfer of complexarthroscopic skills from simulated environments to the operating room andprovide objective parameters to base evaluation. There is a deficiency ofvalidated assessment tools for technical competencies and little consensusof what constitutes a sufficient case volume within the arthroscopycommunity.