Assessment of Technical Competence in Distal Radius Fracture Fixation by a Volar Locking Plate: A Global Delphi Consensus Study

Mads Emil Jacobsen*, Leizl Joy Nayahangan, Monica Ghidinelli, Chitra Subramaniam, Kristoffer Borbjerg Hare, Lars Konge, Amandus Gustafsson


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Purpose: Volar locking plate fixation of distal radius fractures is a common orthopedic procedure and should be mastered by graduating orthopedic residents. Surgical education is transitioning from a traditional time-based approach to competency-based medical education. Valid and objective assessment is essential for successful transition. The purpose of this study was to develop a comprehensive, procedure-specific assessment tool to evaluate technical competence in volar locking plate osteosynthesis of a distal radius fracture. Methods: International orthopedic/trauma experts involved in resident education participated as panelists in a four-round online Delphi process to reach consensus on the content of the assessment tool. Round 1 was an item-generating round, in which the panelists identified potential assessment parameters. In round 2, the panelists rated the importance of each suggested assessment parameter and reached consensus on which to include in the assessment tool. Round 3 yielded specific assessment score intervals for specific bone and fracture models and is not reported in this study. In round 4, the panelists assigned weights to the assessment parameters on a 1–10 scale to determine how each parameter should have an impact on the overall results. Results: Eighty-seven surgeons, representing 42 countries, participated in the study. Round 1 resulted in 45 assessment parameters, grouped into five procedural steps. After round 2, the number of parameters was reduced to 39. After the final round, an additional parameter was removed and weights were assigned to the remaining parameters. Conclusions: Using a systematic methodology, a preliminary assessment tool to evaluate technical competence in distal radius fracture fixation was developed. A consensus of international experts supports the content validity of the assessment tool. Clinical relevance: This assessment tool represents the first step in the evidence-based assessment essential for competency-based medical education. Before implementation, further studies exploring validity of variations of the assessment tool in different educational contexts are required.

TidsskriftJournal of Hand Surgery
Udgave nummer9
Sider (fra-til)875-885
StatusUdgivet - sep. 2023

Bibliografisk note

Funding Information:
The authors would like to thank the following for their contributions as panelists in the study: Alexandru Betisor, Clinical Orthopedic Hospital, Republic Of Moldova; Amparo Gomez, Hospital Universitario de la Samaritana, Columbia; An Sermon, University Hospitals Gasthuisberg, Leuven, Belgium; Andrey Smirnov, East-Tallinn Central Hospital, Estonia; Anna Ekman, Sodersjukhuset, Stockholm, Sweden; Apipop Kritsaneephaiboon, Songklanagarind Hospital, Thailand; Brad Yoo, Yale University, USA; Brett Crist, University of Missouri, USA; Chya Wei Wong, Kumpulan Perubatan Johor Sibu Specialist Medical Centre, Malaysia; Col Dr Narayan Ramachandran, Private practice, Oman; Desai Dhaval, Surat Municipal Institute of Medical Education and Research, India; Devashis Barick, Nandkishor Pralhad Salve Institute of Medical Sciences and Research Centre, India; Eladio Saura-Sanchez, University Hospital of Elche, Spain; Eric S. Moghadamian, University of Kentucky, USA; F.P. du Plessis, Life Rosepark, Rep. of South Africa; Fareed Kagda, Ng Teng Fong General Hospital, Singapore; Frank Damborg, Lillebaelt Hospital, Kolding, Denmark; George Babis, National and Kapodistrian University of Athens, Konstantopouleio Hospital, Greece; Greg M. Osgood, Johns Hopkins School of Medicine, USA; Hashem Al Qdhah, Jordan hospital, Jordan; Hayder Saleh Abdul-Hadi, Rashid Hospital and Trauma Center, United Arab Emirates; Héctor J. Aguado, Hospital Clínico Universitario Valladolid, Spain; Jaimo Ahn, University of Michigan, USA; James Krieg, Thomas Jefferson University, USA; Jaroslaw Brudnicki, University Hospital Collegium Medicum Jagiellonian University, Poland; Jean Pierre Leung, Notre Dame de Chartres Hospital, Philippines; John A. Scolaro, University of California, Irvine, USA; Jon Mutimer, Gloucester, UK; Kai Jensen, University Hospital Zürich, Switzerland; Khaled Hussein, Nini Hospital, Lebanon; Kun Zhang, Xian Honghui Hospital, P.R. China; Kyle Schweser, University of Missouri, USA; Luis Ochoa Olvera, American British Hospital, México; Marco Berlusconi, Azienda Socio-Sanitaria Territoriale Lariana, Italy; Marcos de Camargo Leonhardt, Instituto de ortopedia e traumatologia do hcfmusp, Brazil; Marcos Noberto Giordano, Hospital de Força Aérea do Galeão (HFAG), Brazil; Marie Fridberg, Aalborg university hospital, Denmark; Marinis Pirpiris, Cabrini Hospitals Melbourne, Australia; Mark C. Reilly, University Hospital, Newark, USA; Mark S. Vrahas, Cedars-Sinai, USA; Martin Kloub, Ceske Budejovice, Czech republic; Matej Cimerman, University Clinical Centre Ljubljanaa, Slovenia; Mazen Abdalla, Najah National University Hospital, Palestine; Michael Baumgaertner, Yale New Haven, USA; Mircea Radu Popescu, Emergency County Hospital Timisoara, Romania; Mitchell Bernstein, McGill University Health Center, Canada; Nicola Annicchiarico, Gravedona, Italy; Nitin Kimmatkar, Trauma care Center Government Medical college Nagpur, India; Osvaldo Andres Gonzalez, Instituto de Previsión Social, Paraguay; Paul-Martin Sutter, Spitalzentrum Biel, Switzerland; Peter Jacko, University Hospital Bratislava, Slovakia; Peter Max Halschou-Jensen, Herlev University Hospital, Denmark; M. A. Wajid, Shalamar Medical and Dental College Lahore, Pakistan; Rastislav Burda, University Hospital of Louis Pasteur, Slovakia; Rodrigo Pesantez, Fundacion Santa Fe de Bogota, Columbia; Samir Mehta, University of Pennsylvania, USA; Seng Yew Poh, Singapore General Hospital, Singapore; Sergei Taggesell Fischer, Hospital do Trabalhador, Brazil; Søren Kold, Aalborg University Hospital, Denmark; Søren Kring, University Hospital of Hvidovre, Denmark; Taco Bijlsma, Northwest Hospital Group Alkmaar, The Netherlands; Takashi Miyamoto, Nagasaki University Hospital, Japan; Tomo Havliček, University Medical Centre Ljubljana, Slovenia; Valentin Neuhaus, University Hospital Zurich, Switzerland; Vincenzo Giordano, Hospital Municipal Miguel Couto, Brazil; William T. Lavadia, St. Luke's Medical Center, Philippines; Yazan J. Hattar, Private sector, Jordan; and Yoram A. Weil, Hadassah Hebrew University Hospital, Jerusalem, Israel. The authors would also like to acknowledge the financial support received for this research from the following sources: Toyota-Fonden, Denmark (grant number: KJ/BG-10053H), Helsefonden, Denmark (grant number: 22-B-0148), and Gangstedfonden, Denmark (grant number: A43414).

Funding Information:
The authors would also like to acknowledge the financial support received for this research from the following sources: Toyota-Fonden , Denmark (grant number: KJ/BG-10053H ), Helsefonden , Denmark (grant number: 22-B-0148), and Gangstedfonden , Denmark (grant number: A43414 ).

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© 2023


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