Standard setting for orthopaedic trauma competencies in postgraduate specialty training- catching those falling behind the curve

Background

The Curriculum for Trauma and Orthopaedics focuses on producing competent Day-One Consultants. However, the expected development trajectory is not clear. It is important, yet difficult to objectively identify trainees who are “falling behind”. This project proposes practical, consensus-based thresholds of Operative Trauma Competence at each Waypoint stage of training.

Methods

32 trainers and 73 trainees in one Deanery were identified. The trainers and trainees were asked their PBA level expectation of a trainee at ST4, ST6 and ST8 for nine trauma competencies. Lower quartile values were calculated providing thresholds.

Results

53 (72%) trainees and 22 (69%) trainers responded. At ST8, the lower quartile threshold was level 4 for all procedures. At ST6, three operation groups became apparent: Group 1 (hip hemiarthroplasty, Dynamic hip screw; k-wire distal radius fracture and Weber C Ankle open reduction, internal fixation (ORIF)) Group 2 (Tibial Nail; Olecranon Tension band wire, ORIF radial shaft; distal radius plate fixation)- Group 3 (supracondylar fracture fixation)Threshold levels for procedures were: Group 1- 4a; Group 2–3b and Group 3- 3a.At ST4, there was more variation and spread in responses, however, expectations could still be similarly grouped: Group 1- 3a; Group 2- 2b and Group 3- 2a.

Conclusion

In an increasingly competency-based training environment we provide tangible thresholds for expectations of orthopaedic trainees’ progression and development. We identified two groups: basic trauma (Group 1 where level 4 competencies should be attained by ST6) and intermediate trauma (Groups 2 and 3 where level 4 competencies should be attained by ST8.)