Seven Years of Resident Training with the 5-steps Program in Orthopedic Residency - Clinical and Surgical Skills Courses for Minimizing the Extent of Mistakes and Enhancing Patient Safety

Background:
A century after Halsted inaugurated the first surgical residency, the apprenticeship model of “see-one, do-one, teach-one” is wearying at the era of patient safety. With the reported success of simulation training in literature, the American Board of Orthopaedic Surgery (ABOS) requires that surgical simulation training be part of the curricula. Working hours regulations have shortened the residency, yet more procedures are required to be mastered. We suggest a 5-step training program throughout residency to enhance clinical and surgical competency.

Objective:
Implementation of orthopedic skills courses during residency.

Methods:
Since 2014, the implementation of the skills courses has been established. The 5 steps represent the different requirements during residency, with increasing clinical and surgical capabilities. Step 1: Intended for residents in their first days in the ward, teaching them the essence of management of hospitalized patients. Step 2: Surgical boot camp, providing general surgical manners and skills, including a casting course. Step 3: ER orthopedics – triage and management of orthopedic patients in the emergency department. Step 4: Surgical management of orthopedic trauma, surgical skills, and knowledge course. Step 5: Senior resident course – advanced surgical and clinical management of patients during night shifts.

Results:
In total, 12 residents passed step 1 (5 courses, 2018-2021), 24 residents passed step 2 (6 courses 2014-2021), 22 residents passed step 3 (5 courses, 2015-2021), 19 residents passed step 4 (2 courses, 2017 and 2021), 17 residents passed step 5 (6 courses, 2017-2021). Most of the residents thought that the step courses assisted them to a considerable degree (average 3.9 of 4 (SD 0.3)) and unanimously pointed that they would strongly suggest including this practice in residency programs.

Conclusions:
The 5-step program is a desirable way to augment resident skills during residency, providing important tools needed for minimizing the extent of mistakes and enhancing patient safety.