Objective Assessment of Orthopaedic Skills

Introduction: We have been using task trainers for teaching various techniques such as injections for carpal tunnel, trigger finger and tenosynovitis and knee lavage. However, at present these skills are being taught in a nonsystematic manner and we do not have an objective method of evaluating them. The aim of this study was to device an objective tool for measurement of these skills. Methods: A total of 80 fourth year MBBS students participated in the study. A MCQ test was used for base line assessment of student’s knowledge of the knee anatomy. The students were divided into three groups for instruction on knee joint injection i.e. didactic (lecture), video and hands on training group. The three groups performed a task of simulated knee joint injection on an anatomical knee model and assessed using a newly prepared assessment tool. A second MCQ test was conducted after the joint injection task. Each participant was asked to rate his or her confidence in performing knee joint injections with use of l0-point Likert scale before and after the instruction. Results: On comparing the means by one-way Anova, the mean score was highest for the hands on training group (26.32) followed by video group (20.46) and lecture group (16.15) respectively. The difference in the scores between three groups was statistically significant (p<0.000). Participants in all three groups showed gain in knowledge and confidence at performing the task. The overall internal consistency (cronbach’s alpha) of the assessment tool developed was 0.63. However high convergent validity (inter-item correlation) was found for 8 out of 9 items of the assessment tool. Conclusion: Availability of an objective assessment tool for orthopaedic skills will systemize the delivery and evaluation of these skills. Further the experience gained through this study will be used to develop objective assessment tools to evaluate the skills in other medical disciplines.