Learning and Retaining Simulated Arthroscopic Meniscal Repair Skills

• DOI: 10.2106/jbjs.k.01438
• Publication Date: 2012-11-15T20:56:59Z
• Authors: W.F.M. Jackson; T. Khan; A. Alvand; S. Al-Ali; H.S. Gill; A.J. Price; J.L. Rees
• Keywords: Adult; Male; Internship and Residency; Reproducibility of Results; Retention, Psychology; Knee Injuries; Menisci, Tibial; Statistics, Nonparametric; Cohort Studies; Arthroscopy; 03 medical and health sciences; Orthopedics; 0302 clinical medicine; Education, Medical, Graduate; Task Performance and Analysis; Humans; Computer Simulation; Female; Clinical Competence; Learning Curve

Previous studies of task-specific skills have suggested that a loss of technical performance occurs if the skill is not practiced for a six-month period. The aims of this study were to objectively demonstrate the learning curve for a complex arthroscopic task (meniscal repair) by means of motion analysis and to determine the impact of task repetition on the retention of this skill.Nineteen orthopaedic residents with experience in routine knee arthroscopy but not in arthroscopic meniscal repair were recruited into a randomized study. During the initial learning phase, all subjects performed twelve meniscal repairs on a knee simulator over a three-week period. A validated motion analysis tracking system was used to objectively record the performance and learning of each subject; the outcomes were the time taken, distance traveled, and number of hand movements. The subjects were then randomized into three groups. Group A performed one meniscal repair each month, Group B performed one meniscal repair at three months, and Group C performed no repairs during this interim phase. All three groups then returned at the six-month point for the final assessment phase, during which they carried out an additional twelve meniscal repairs over three weeks.All subjects demonstrated a clear learning curve during the initial learning phase, with significant objective improvement in all motion analysis parameters over the initial twelve episodes (p < 0.0001). Although some residents had reached a learning plateau by twelve episodes, others continued to make further improvements for up to another nine episodes. Importantly, Group C did not display any loss of skill between the initial learning phase and final evaluation phase despite a six-month break in task repetition (p > 0.05).In contrast to previous studies, residents did not lose any skill over a six-month interruption in task performance, and other residents took longer to produce a more consistent performance.