Authors (including presenting author) :
CHEUNG VKL(1), LEE KB(2), CHUI TKH(2), SO EHK(1), LEUNG ASH(1), CHIA NH(1), LI W(2)
Affiliation :
(1)Multi-Disciplinary Simulation and Skills Centre, Kowloon Central Cluster,(2)Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital
Introduction :
Trauma is one of the top ten leading causes of mortality and morbidity worldwide. To keep abreast of increasing needs of managing patients with hemodynamically unstable pelvic fractures, “3-in-1 pelvic damage control protocol” and External-fixation techniques have been incorporated into curriculum compulsory for Higher Orthopedic Trainees (HOTs) under HA corporate training since August 2017.
Objectives :
1) To examine whether timed performance in External-fixation (Anterior External-fixation as “Anterior Ex-Fix” and Posterior External-fixation as “C-Clamp”) differs significantly among levels of HOTs (“HOT1”, “HOT2”, “HOT3” and “HOT4 and fellow”) 2) To provide evidence of how grouping arrangement (by cluster v.s. shuffled) affects task performance
Methodology :
Sixty-six doctors who registered at Hong Kong College of Orthopedic Surgery (HKCOS) as HOTs or fellows were included in the study (Table 1: Demographic table). Restricted with age ranged from 20 to 35 and male-female ratio (within 6:4 to 7:3), participants were assigned into groups of 7 or 8 by different mechanism: Group1 by cluster (2017), Group2 randomly assigned with fixed quota of levels of HOTs (2018). To avoid practicing effect, only one trial was carried out for each participant (Figure 1: Standard procedure & equipment).
Result & Outcome :
[RESULTS] Due to non-normality and small sample size of sub-groups, non-parametric tests were used. (Task Performance among HOT Levels): Applying Kruskal-Wallis tests, neither did Anterior Ex-Fix [H(3)= 1.79, p=.62] nor C-Clamp [H(3)= 1.10, p=.78] show any significant rank differences among levels of HOTs. (Grouping Effect): Of 66 participants, 30 and 36 were assigned into Group1 (Mdn_Anterior= 613, IQR_Anterior= 420.25 - 675.75; Mdn_C-Clamp= 351, IQR_C-Clamp= 330 - 387) and Group2 (Mdn_Anterior= 707.5, IQR_Anterior= 619 - 804.5; Mdn_C-Clamp= 339, IQR_C-Clamp= 277 - 478), respectively. The results of Mann-Witney U test showed a significant between-group difference in Anterior Ex-Fix, but not in C-Clamp (U= 472, p=.38, Z= -.88). The Mdn_Anterior was significantly shorter for Group1 than for Group2 (U= 290.5, p<.001, Z= -3.21). [CONCLUSION] Good Practice and communication makes perfect. The study proved that trainees’ performance of Anterior External-fixation would not be enhanced following natural growth in seniority of HOTs levels, but be facilitated when grouping with members from the same cluster. The findings reconfirmed the practical value of putting such component into HOTs mandatory training and for fellows as a skills-reinforcing session. By speculation, grouping with familiar counterparts can maximize learning effect because of openness and willingness to share, perceived relevance of clinical experience, as well as positive in-group competition under time pressure.
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