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Assessment of Resident Technical Skill with the Use of a Novel Cubital Tunnel Release
Kavita T. Vakharia, MD, MS, Mark D. Hatch, MD, Randy M. Hauck, MD, Kenneth F. Taylor, MD.
Penn State Hershey Medical Center, Hershey, PA, USA.

BACKGROUND: Development of a standardized, validated skills assessment for plastic surgery education can help ensure that graduating residents will possess the minimum knowledge, judgment and technical skills required for safe performance of a core subset of procedures. Previously published work has described a structured skills assessment that is administered to residents of a single orthopedic surgery program. This project aims to illustrate the ease with which a novel cubital tunnel release approach can be taught to novice surgeons as well as describing a validated tool for assessment of surgical skill directly relating to a procedure commonly performed by plastic surgeons.
METHODS: Ten plastic surgery and orthopedic surgery residents of varying years participated in this study. The technique that the residents were tested on was presented to them via Powerpoint format fifteen minutes prior to their examination. The technique that was introduced and examined for cubital tunnel release was a minimally invasive approach that used the lighted breast retractors (ASSI). After exposure of the cubital tunnel was obtained in a fresh cadaver arm through an approximately 3cm incision, progressively longer lighted retractors were sequentially placed to facilitate visualization and decompression of the cubital tunnel and the distal and proximal possible sites of compression. The resident evaluation was performed by one of our CAQ board-certified hand surgeons. The surgeon used a detailed checklist of required surgical steps; a global rating scale; timed the procedure; and finally, performed a dissection to assess for complications. Study data was compared between junior and senior residents and a rho correlation analysis was performed to verify the validity of the assessment tools.
RESULTS: Validation measurements showed strong correlations between the pass/fail grade and the detailed checklist (r=0.8) and the global rating scale (r=0.6). Training year was most strongly correlated with the global rating scale (r=0.8) and there was a trend towards faster surgical time in the senior resident cohort. Two junior residents obtained a failing grade due to the occurrence of an adverse event, incomplete release. All residents completed a survey describing their prior experience with the procedure which showed all senior residents had prior experience with this procedure however only two had previously performed the lighted retractor technique. None of the junior residents had prior experience with performing the standard cubital tunnel release.
CONCLUSIONS: This study demonstrated that surgical residents were able to learn this novel cubital tunnel release technique and immediately perform the procedure in an examination setting with relative ease. All senior residents achieved full release of the cubital tunnel with no complications with the use of the lighted breast retractors. This study also highlighted the importance of simulated clinical assessments to the advancement of a resident's education. Furthermore, all residents were in favor of including this and similar technical skill assessments in their curriculum to ensure they obtain targeted areas of improvement required for them to be well prepared for their practice after completion of their training program.

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