Arthroscopic Proficiency: A Survey of Orthopaedic Sports Medicine Fellowship Directors and Orthopaedic Surgery Department Chairs Patrick J. O’Neill, M.D., Andrew J. Cosgarea, M.D., Jason A. Freedman, M.D., William S. Queale, M.D., M.H.S., and Edward G. McFarland, M.D. Purpose: The goal of this study was to evaluate the opinion of sports medicine fellowship directors and orthopaedic surgery department chairpersons on how many repetitions the average resident needs to become proficient in several common arthroscopic procedures. Type of Study: A cross-sectional study. Methods: A questionnaire was mailed to all fellowship directors on a list maintained by the American Academy of Orthopaedic Surgeons and to all department chairpersons on a list maintained by the American Medical Association. Respondents were asked to estimate the number of operations needed for a trainee to reach minimal proficiency (able to perform procedure skin-to-skin with supervision) and proficiency (capable of performing procedure without supervision) for 5 common arthroscopic proce- dures: diagnostic knee scope, partial medial meniscectomy, anterior cruciate ligament (ACL) reconstruc- tion, diagnostic shoulder scope, and subacromial decompression. Results: A total of 164 of 230 (71%) people responded to the questionnaire. Department chairpersons who did not perform arthroscopy consistently estimated two thirds the number of operations that department chairpersons who did perform arthroscopy and nearly half the number of operations estimated by fellowship directors. Chairpersons who did perform arthroscopy had responses more similar to fellowship directors than to department heads who did not perform arthroscopy. Conclusions: These results indicate that, in the opinion of physicians involved in the education of residents and fellows, it may take a substantial number of repetitions to become proficient in arthroscopy. Physicians who perform little or no arthroscopy themselves may underestimate its difficulty. Interestingly, there was substantial variability in the number of repetitions estimated to achieve proficiency in all procedures. The results of this study may be helpful in designing arthroscopic training programs for orthopaedic residents or sports medicine fellows; however, the wide variability in opinions may indicate difficulty in reaching a consensus. Key Words: Arthroscopy skills—Education—Residents—Fellows—Acromioplasty—Anterior cruciate ligament. R apid technologic growth over the past few de- cades has led to the widespread use of arth- roscopic techniques in orthopaedic surgery. 1,2 Physicians have had to learn technically difficult ar- throscopic skills that also require the development of certain visual-spatial abilities. 3-5 There has been re- cent interest in implementing a certification process to ensure adequate arthroscopic training of orthopaedic sports medicine physicians. 6-8 How much exposure is necessary during orthopaedic residency training is un- certain. Few objective data are currently available regarding competence in arthroscopy, and specific guidelines concerning attainment of competency in arthroscopy are virtually nonexistent. The Residency Review Committee for Orthopaedic Surgery for the Accredi- tation Council for Graduate Medical Education (ACGME) requires a record of the number of proce- From the Department of Orthopaedic Surgery, Union Memorial Hospital (P.J.O.); the Division of Sports Medicine, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland (A.J.C., W.S.Q., E.G.M.); and the Department of Orthopaedic Surgery, UCLA Medical Center, Los Angeles, California (J.A.F.), U.S.A. Address correspondence and reprint requests to Edward G. McFarland, M.D., Johns Hopkins Sports Medicine, 10753 Falls Rd, Suite 215, Lutherville, MD 21093, U.S.A. E-mail: emcfarl@ jhmi.edu © 2002 by the Arthroscopy Association of North America 0749-8063/02/1807-3005$35.00/0 doi:10.1053/jars.2002.31699 795 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 795– 800