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AOTrauma’s Proficiency Curriculum.

The AO Skills Lab—the AO Foundation’s novel procedural training strategy—will soon have proficiency assessment metrics, thanks to a project funded by the AO Strategy Fund.

That project, “Pro-C: AOTrauma’s Proficiency Curriculum,” is led by AOTrauma North America faculty members Pierre Guy (University of British Columbia Department of Orthopedics, Vancouver, CA), Michael Baumgaertner (Yale School of Medicine, New Haven, CT, US), and Matthew L Graves (University of Mississippi Medical Center, Jackson, MS, US). The project team is supported by the AO Education Institute, with Curriculum Developer Katherin Lüssi collaborating to ensure that the new proficiency assessment metrics will integrate well into existing strategies for AOTrauma courses. Engineering work related to the project is being carried out at the Centre for Hip Health and Mobility, a research center located on the Vancouver General Hospital campus.

Guy, a member of AOTrauma North America’s Education Committee, explained that the metrics are based on the recognized proficiency outcomes development model created by Prof Anthony G Gallagher, an internationally recognized expert on metric-based training to proficiency in medical education and a consultant to the Pro-C project team.

The AO Skills Lab, formerly known as the AO Playground, encompasses the practical training sessions that take place at AOTrauma courses. The need for proficiency measures related to the labs is driven by medical trainees working fewer hours, increasing scrutiny of teaching in the operating room, and regulatory and licensing bodies increasingly seeking evidence of clinicians’ competency and proficiency, Guy explained.

“The AO has this great, widely distributed network of teaching events around the world, so it makes sense to apply the best standards to surgical training by developing some metrics around teaching in our labs,” he said. “Anthony Gallagher has developed a process in which surgical trainees’ psychomotor skills are assessed prior to a teaching event. They then go through the training sessions and labs, and then they’re given feedback and allowed to progress so that they can achieve a certain performance threshold.”

Guy said assessing trainees’ psychomotor skills is the most robust way to measure the impact of teaching. Of the ten Skills Labs stations, the Pro-C team chose five (torque measurement of bone screws, soft tissue penetration during drilling, heat generation during drilling, techniques of reduction, damaged implant removal) and the ankle fracture fixation lab from the basic principles course as the pilot for developing the new proficiency assessment metrics. The metrics will first be evaluated by experts from the AOTrauma North America Education Committee. Then, they will be applied at measurement sessions, when experts will carry out the lab tasks and identify various levels of performance to develop a rating scale from novice to expert.

Beyond serving as a valuable tool for measuring skills, Guy said the metrics can be applied to teaching across all the AO’s clinical divisions.

“We’re approaching this in a very progressive way. The idea is to expand the application of metrics not only in trauma, but also to the AO’s other divisions. At our fall courses, faculty members will do the exercises and then residents themselves will perform the tasks and we will find out how they and our metrics approach, performed,” he explained.

Guy said he sees the value of Pro-C from both sides: that of a teacher and that of a student.

“It’s a matter of speeding up the learning curve and doing it in a constructive manner,” he said. “Such proficiency metrics would have been a huge benefit to me when I was a resident. Our knowledge has improved around teaching and we want to employ this “best-of-breed” approach to the great work AO provides every year as a leading international teaching organization.”  

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