Establishing the Learning Curve for Elbow Arthroscopy: Surgeon and Trainee Perspectives on Number of Cases Needed and Optimal Methods for Acquiring Skill

Background Elbow arthroscopy has increased in frequency as its indications have widened. Despite this growth, a learning curve has not yet been defined. Hypothesis We hypothesized there would be significant differences in perspective between trainees and established surgeons for the number of cases needed to reach each skill level and what they felt are the most valuable training tools. Methods Orthopedic attending physicians and trainees were asked to complete a questionnaire assessing participant demographics, case volumes required to reach defined skill levels (novice, safe, competent, proficient and expert) and the efficacy of various learning methodologies for elbow arthroscopy. The value of educational methods was assessed using a 5-point Likert scale (1- not at all valuable and 5- extremely valuable). Results The study population consisted of 323 total participants, of which 224 (69.3%) were attending surgeons and 99 (30.7%) were trainees (resident or fellow physicians). According to the attending physicians, the mean numbers of cases needed to reach each skill level were: 19 to be safe, 42 to be competent, 93 to be proficient and 230 to be expert. These case numbers were not significantly different from the perspectives of trainees. Across the respondents, there were no significant differences in the number of cases needed to reach each level of skill based on the respondents’ level of training, years of experience, type of fellowship, or self-reported skill level. While both groups highly valued live surgery (4.7 of 5) and cadaveric practice (4.6 of 5) for acquiring skill, attendings placed higher value on reading (4.0 vs. 3.3, p Conclusions There was considerable agreement amongst attending surgeons and trainees in terms of the number of cases needed to attain various skill levels of elbow arthroscopy, which was consistent regardless of fellowship background, self-reported skill level, career length, and elbow arthroscopy case volume. However, there was some disagreement between attending surgeons and trainees over the most valuable methods for acquiring surgical skill with trainees placing less value on textbooks, surgical videos, and formal courses compared to attending surgeons. An understanding of the elbow arthroscopy learning curve will help trainees and their training programs establish case volume targets prior to safe, independent practice. Future studies should aim to clinically validate this learning curve.