Document Type: RESEARCH PAPER
Harvard Combined Orthopaedics Residency Program,
Boston, MA, USA
Harvard Medical School, Boston, MA, USA
Program in Global Surgery and Social Change, Boston
Children’s Hospital, Department of Plastic & Oral Surgery,
Boston, MA, USA
Brigham and Women’s Hospital, Department of Orthopaedic
Surgery, Boston, MA, USA
Background: Little is known about how to introduce complex technologies like arthroscopy into low-income countries. Thus, we compared low- versus high-resource intensive methods of teaching basic arthroscopic skills in a randomized controlled trial in Haiti.
Methods: Forty-eight Haitian orthopaedic surgeons and residents attending an orthopaedic conference in Haiti were block randomized to receive instruction through a composite video (Control) or a composite video plus hands-on teaching with an expert visiting surgeon (Intervention). A low-fidelity surgical simulator tested visualization and triangulation skills. Participants completed a pre- and post-test where the goal was to sequentially tap the most numbers in 2.5 minutes. Outcome metrics included highest tapped number, number of errors, visualization loss, and number of lookdowns.Multivariate linear regression was used to confirm randomization and compare outcomes between groups.
Results: Seventy-five percent of initially randomized attendees participated with similar attrition rates between both groups. All participants who performed a pre-test completed a post-test. In terms of highest tapped number, treatment and control groups significantly improved compared to pre-test scores, with mean improvement of 3.2% (P=0.007) and 2.2% (P=0.03), respectively. Improvement between treatment and control groups was not statistically different (P=0.4). No statistically significant change was seen with regard to other metrics.
Conclusion: We describe a protocol to introduce basic arthroscopic skills in a low-income country using a low-resource intensive teaching method. However, this method of learning may not be optimal given the failure to improve in all outcome measures.