Orthopaedic Resident Preparation and Confidence in Treating On-Field Injuries

Abstract

Background:Orthopaedic surgery residents may cover athletic events, although the training provided to prepare residents for this role and oversight from attending physicians during these activities is not well understood.Purpose:To survey orthopaedic residents about the training provided by their residency program for on-field athletic coverage and to understand their levels of preparation for this role and confidence in treating commonly encountered on-field conditions.Study Design:Descriptive epidemiology study.Methods:An anonymous survey was emailed to residents in all American College of Graduate Medical Education–accredited, allopathic, nonmilitary orthopaedic surgery residency programs. This survey queried residents about their demographics, the opportunities their residencies require or allow for athletic coverage, their level of preparation for serving an on-field physician, and their comfort level with treating a number of on-field conditions. Likert-type scales were used to assess resident comfort level for treating 13 orthopaedic and nonorthopaedic conditions as well as their perceived level of preparedness.Results:Of 148 residency programs contacted, 57 programs responded (39%). Of the 57 programs responding, 51 (89.5%) allowed or required residents to cover athletic events, and 27 of 51 (52.9%) reported that training to prepare for this role was provided. Only 6 of 24 programs without training available (25%) had direct attending supervision of residents at all athletic events. Residents who answered that their residency programs mandate training prior to their participation in athletic coverage activities reported a higher level of preparation for this role than those with no training, optional training, or those who were unsure of their training requirement (P < .0001, P = .035, and P = .013, respectively). In addition, the more senior the resident was, the higher the level of confidence was in treating all orthopaedic and some nonorthopaedic conditions. Residents who had mandatory training displayed a higher comfort level in treating on-field orthopaedic and nonorthopaedic conditions than those without training.Conclusion:Formal training of orthopaedic residents prior to their covering athletic events can improve confidence in treating orthopaedic and nonorthopaedic conditions. Many programs do not ensure that residents are familiar with key and potentially life-saving equipment. An opportunity exists to improve resident education.

The Role of Athletic Event Coverage in Orthopaedic Residency Training: A National Survey of Residency Program Directors

“…12 Unfortunately, a surprisingly high number of programs reported a lack of oversight by attending physicians during resident event coverage. This is similar to a survey of residents by Hodax et al 5 who found that 32% of programs had direct attending supervision at all events and 39% had variable supervision by attending surgeons. Supervision and mentorship by attending surgeons may be particularly valuable in role modeling sideline evaluation and medical professionalism in the community setting.…”

“…[1][2][3][4] Orthopaedic surgeons are frequently called on to serve as medical personnel for organized youth, adolescent, collegiate, and professional sporting events. [5][6][7] The pathology that a team physician may encounter during athletic events includes a broad array of medical, dental, ophthalmic, neurologic, and musculoskeletal conditions.…”

“…[1][2][3][4] Orthopaedic surgeons are frequently called on to serve as medical personnel for organized youth, adolescent, collegiate, and professional sporting events. [5][6][7] The pathology that a team physician may encounter during athletic events includes a broad array of medical, dental, ophthalmic, neurologic, and musculoskeletal conditions.Despite the importance of athletic event coverage in orthopaedics, no Accreditation Council for Graduate Medical Education (ACGME) recommendations exist regarding its role in resident education. Hodax et al 5 recently reported that although 90% of residency programs provide opportunities for resident involvement in athletic event coverage, nearly half of the programs do not provide formal training on this unique skill.…”

Should every physician be ready to act as a community first responder?

“…Many orthopaedic surgeons serve on the sidelines during sporting events to render medical care to the injured athlete as needed. Whilst most orthopaedic surgeons are comfortable managing musculoskeletal injuries (which are involved in over 70% of on-field evaluations), these are not the only medical emergencies that occur [18] .…”

“…A 2017 study of orthopaedic residents acting as team physicians showed that whilst residents’ confidence in managing musculoskeletal sideline injuries grew consistently over the five years of their training, their confidence in managing other serious on-field medical emergencies such as commotio cordis, concussion, dehydration, heat injury, and ocular injury did not [18] . The conclusion of this study was that the provision of additional training for these physicians was the most desirable solution [18] .…”