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Resident Independence Performing Common Orthopaedic Procedures at the End of Training

Perspective of the Graduated Resident

Kohring, Jessica M. MD1; Harrast, John J. MS2; Stotts, Alan K. MD1; Zhang, Chong MS1; Millar, Morgan M. PhD, MA1; Presson, Angela P. PhD1; Saltzman, Charles L. MD1

The Journal of Bone and Joint Surgery: September 20, 2019 - Volume Latest Articles - Issue - p
doi: 10.2106/JBJS.18.01469
Topics in Training: PDF Only

Background: The Accreditation Council for Graduate Medical Education (ACGME) has established minimum exposure rates for specific orthopaedic procedures during residency but has not established the achievement of competence at the end of training. The determination of independence performing surgical procedures remains undefined and may depend on the perspective of the observer. The purpose of this study was to understand the perceptions of recently graduated orthopaedic residents on the number of cases needed to achieve independence and on the ability to perform common orthopaedic procedures at the end of training.

Methods: We conducted a web survey of all 727 recently graduated U.S. orthopaedic residents sitting for the 2018 American Board of Orthopaedic Surgery Part I Examination in July 2018. The surveyed participants were asked to assess the ability to independently perform 26 common adult and pediatric orthopaedic procedures as well as to recommend the number of cases to achieve independence at the end of training. We compared these data to the ACGME Minimum Numbers and the average ACGME resident experience data for residents who graduated from 2010 to 2012.

Results: For 14 (78%) of the 18 adult procedures, >80% of respondents reported the ability to perform independently, and for 7 (88%) of the 8 pediatric procedures, >90% reported the ability to perform independently. The resident-recommended number of cases for independence was greater than the ACGME Minimum Numbers for all but 1 adult procedure. For 18 of the 26 adult and pediatric procedures, the mean 2010 to 2012 graduated resident exposure was significantly less than the mean number recommended for independence by 2018 graduates (p < 0.05).

Conclusions: Overall, recently graduated residents reported high self-perceived independence in performing the majority of the common adult and pediatric orthopaedic surgical procedures included in this study. In general, recently graduated residents recommended a greater number of case exposures to achieve independence than the ACGME Minimum Numbers.

1Departments of Orthopaedics (J.M.K., A.K.S., A.P.P., and C.L.S.) and Internal Medicine (C.Z., M.M.M., and A.P.P.), University of Utah, Salt Lake City, Utah

2Data Harbor Solutions, Hinsdale, Illinois

Email address for C.L. Saltzman:

Investigation performed at the Department of Orthopaedics, University of Utah, Salt Lake City, Utah

Disclosure: This study was supported by a grant from the National Institutes of Health (NIH 5UL1TR001067-05) and supported in part by a grant from the NIH National Center for Advancing Translational Science (NIH-NCATS 1UL1TR002538-01) to the University of Utah Center for Clinical and Translational Science. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright 2019 by The Journal of Bone and Joint Surgery, Incorporated
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