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Assessing technical skill in ankle fracture surgery from the postoperative radiograph
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James, Hannah, Griffin, James M. and Pattison, Giles T. R. (2022) Assessing technical skill in ankle fracture surgery from the postoperative radiograph. Bone & Joint Open, 3 (6). pp. 502-509. doi:10.1302/2633-1462.36.BJO-2021-0212.R1 ISSN 2633-1462.
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Official URL: https://doi.org/10.1302/2633-1462.36.BJO-2021-0212...
Abstract
Aims
To identify a core outcome set of postoperative radiographic measurements to assess technical skill in ankle fracture open reduction internal fixation (ORIF), and to validate these against Van der Vleuten’s criteria for effective assessment.
Methods
An e-Delphi exercise was undertaken at a major trauma centre (n = 39) to identify relevant parameters. Feasibility was tested by two authors. Reliability and validity was tested using postoperative radiographs of ankle fracture operations performed by trainees enrolled in an educational trial (IRCTN 20431944). To determine construct validity, trainees were divided into novice (performed < ten cases at baseline) and intermediate groups (performed ≥ ten cases at baseline). To assess concurrent validity, the procedure-based assessment (PBA) was considered the gold standard. The inter-rater and intrarater reliability was tested using a randomly selected subset of 25 cases.
Results
Overall, 235 ankle ORIFs were performed by 24 postgraduate year three to five trainees during ten months at nine NHS hospitals in England, UK. Overall, 42 PBAs were completed. The e-Delphi panel identified five ‘final product analysis’ parameters and defined acceptability thresholds: medial clear space (MCS); medial malleolar displacement (MMD); lateral malleolar displacement (LMD); tibiofibular clear space (TFCS) (all in mm); and talocrural angle (TCA) in degrees. Face validity, content validity, and feasibility were excellent. PBA global rating scale scores in this population showed excellent construct validity as continuous (p < 0.001) and categorical (p = 0.001) variables. Concurrent validity of all metrics was poor against PBA score. Intrarater reliability was substantial for all parameters (intraclass correlation coefficient (ICC) > 0.8), and inter-rater reliability was substantial for LMD, MMD, TCA, and moderate (ICC 0.61 to 0.80) for MCS and TFCS. Assessment was time efficient compared to PBA.
Conclusion
Assessment of technical skill in ankle fracture surgery using the first postoperative radiograph satisfies the tested Van der Vleuten’s utility criteria for effective assessment. 'Final product analysis' assessment may be useful to assess skill transfer in the simulation-based research setting.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RD Surgery | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
Library of Congress Subject Headings (LCSH): | Ankle -- Fractures -- Surgery -- Evaluation, Ankle -- Surgery -- Evaluation, Surgery -- Evaluation | ||||||
Journal or Publication Title: | Bone & Joint Open | ||||||
Publisher: | British Editorial Society of Bone and Joint Surgery | ||||||
ISSN: | 2633-1462 | ||||||
Official Date: | 20 June 2022 | ||||||
Dates: |
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Volume: | 3 | ||||||
Number: | 6 | ||||||
Page Range: | pp. 502-509 | ||||||
DOI: | 10.1302/2633-1462.36.BJO-2021-0212.R1 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 29 July 2022 | ||||||
Date of first compliant Open Access: | 29 July 2022 | ||||||
RIOXX Funder/Project Grant: |
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