All licensed doctors are required to revalidate from June 2012. The GMC states that patient feedback should form part of doctors provided evidence. A standardised GMC PSS has been shown to offer a reliable basis for the assessment of professionalism among UK doctors and has been suggested as a tool for revalidation. We aim to show its use in the secondary care setting to be simple and effective, offering further evidence for doctors undergoing revalidation. Having sought permission from the Trust the GMC PSS was used in the manner directed for 3 doctors in a Trauma and Orthopaedic fracture clinic. The data was analysed using an automated system and the results made available to individual clinicians in a simple to present format. 3 clinicians used the survey across 13 clinic sessions. The mean number of clinics it took to generate sufficient responses was 3.25 (range 2–5). We found the survey easy to use, HCAs handed forms to patients before consultation. Survey results were collected as patients left clinic and analysed by the Patient Services Department. The GMC PSS, although designed principally for use in Primary care appears to be a useful tool in secondary care

Soon, UK surgeons will need to undergo regular revalidation and relicensing. As a part of this process they will need to collect accurate outcomes data. However, a lack of standardisation has led to numerous generic and disease specific outcome tools being available with increasing complexity in their administration and interpretation. In research and university settings these tools are easily administered, but in a busy general spinal practice with limited human and time resources, it may not be possible to use them reliably and consistently. Web-based systems remove some of these problems, but data-input can be time consuming. This study evaluates the utility of a subjective Patient Satisfaction Evaluation Questionnaire (PSE) by comparing it to well-known outcome tools, the Oswestry disability Index (ODI) and the Low Back Outcome Score (LBOS). The PSE (modified Odom’s Criteria) evaluates pain, the willingness to undergo surgery again in similar circumstances, the likelihood of recommending the operation undergone to a friend or family member and satisfaction with the process of care. Pain relief is ranked as “complete”, “good but not complete”, “little” or “no pain relief/pain worse than before surgery”. The responses are scored with three points allocated to complete relief of pain, down to none for no relief. The other questions score one for a positive and zero for a negative response. The maximum score is six. Four, five or six points count as success as long as the pain component is two or three. Nought to three, counts as failure, as does a score of four when pain is rated as “poor”. The ODI, LBOS and PSE are not directly numerically comparable, but the results of them all can be grouped into “Success” and “Failure” which gives a basis for comparison of the tools. 150 consecutive patients who underwent lumbar spine surgery completed the three questionnaires independently of the treating surgeon. The scores were subjected to regression analysis (R square) and a Pearson’s correlation. Feedback was sought from the patients regarding the “user friendliness” of the questionnaires. Results showed a good correlation between the ODI and LBOS with a Pearson’s value and R Square (RSQ) value of 0.86 and 0.75 respectively. The PSE compared to the ODI showed a Pearson’s value of 0.86 and RSQ of 0.74. The LBOS and PSE comparison had a Pearson’s value of 0.78 and RSQ of 0.61. The results show that the PSE in the form used correlates well with results from the ODI and LBOS. However, the patient feedback data indicated that the PSE was the most user friendly of the three tools. The PSE was found to be a useful and user friendly tool, correlating well with recognised outcome measures, being easy to administer, document and interpret. If surgeons with limited resources cannot reliably use a more rigorous outcome tool, using the PSE should provide enough data to meet the standards that are likely to be required for revalidation and relicensing

Purpose:

To examine the feasibility of surgical outcome measures for a children's orthopaedic surgeon when compared with other specialties.

The incidence of post-operative peri-prosthetic fractures is increasing. This is a consequence of the larger number of revision cases being undertaken, the increase in the use of cementless implants and a number of patients who develop undetected osteolysis as a result of poor follow up. The Vancouver classification has been shown previously, in North America, to be a valid and reliable method for determining the configuration of a periprosthetic fracture. This is essential in directing the fractures further management appropriately and the classification system has been adopted by surgeons throughout the world.

The reliability of any classification system depends on the reproducibility between the clinicians who are making the management decisions. We have revalidated this classification system, independently from the original authors, at a centre in Europe. The radiographs from 30 patients with peri-prosthetic fractures were reviewed by 6 expert consultant surgeons, 6 non-experts at registrar level and 6 medical students, who had received no specialist teaching in this area, in order to assess intra and inter-observer reliability and reproducibility. Each observer read the radiographs on 2 separate occasions and classified the fracture according to its type (A, B1, B2, B3, and C). The results were subjected to weighted kappa analysis and were: 0.76 (substantial agreement) for experts; 0.68 (substantial agreement) for non-experts; and 0.61 (substantial agreement) for medical students.

Our results confirm the reliability and reproducibility of this classification system. In addition we have shown that substantial agreement can even be found between individuals with no specialist training. This is a classification system that can be reliably used by non-experts, between centres and across continents.

Introduction: The incidence of post-operative peri-prosthetic fractures is increasing. This is a consequence of the larger number of revision cases being undertaken, the increase in the use of cementless implants and a number of patients who develop undetected osteolysis as a result of poor follow up. The Vancouver classification has been shown to be a valid and reliable method for determining the configuration of periprosthetic fractures. This is essential in directing the further management of periprosthetic fractures appropriately.

Methods: We have revalidated this classification system independently from the original authors at our institution. The radiographs from 30 patients with peri-prosthetic fractures were reviewed by 6 expert consultant surgeons, 6 non-experts at registrar level and 6 medical students, who had received no specialist training in this area, in order to assess intra and inter-observer reliability and reproducibility. Each observer read the radiographs on 2 separate occasions and classified the fracture according to its type (A, B1, B2, B3, and C).

Results: The results were subjected to weighted κ analysis and were: Intraobserver agreement 0.72 for experts,0.68 for non experts and 0.61 for medical students. Interobserver agreement was 0.63 for the first reading and 0.67 for the second reading. Validity analysis showed a κ value of 0.79 (substantial agreement).

Discussion: Our results confirm the reliability and reproducibility of this classification system. In addition we have shown that substantial agreement can even be found between individuals with no specialist training. This is a classification system that can be used by non-experts, between centres and across continents.

Quality Improvement (QI) is of increasing importance with its inclusion on training curricula and requirement for it in revalidation. Junior Doctors are a valuable, yet under utilised resource for NHS Trusts in patient safety/Quality Improvement activity. A Trainee led QI Academy, supported and administered by Medical Education was launched in our Trust. It offered education on Leadership and Management and support for projects from the Trust Service and Development teams. The QI Academy launch evening attracted over 60 Trainees and 17 QI projects were adopted. Subsequently a further 9 projects have been started and a number published in peer reviewed journals and presented internationally. The Academy was an attractive and supportive method of engaging new groups of doctors. QI is not as constrained as simple audit, and as such, engaging trainees has proven to be easier. Collaboration between a Core Faculty, Trainees and Trust Management ensured adequate and sustainable support for all projects, avoided duplication and fostered a closer relationship. We highly recommend Trust support of QI in junior doctors through Medical Education. Trusts benefit from improvements in patient care and quality whilst trainees learn valuable skills and benefit from presentations and publications

The Royal College of Surgeons of England (RCS) recently issued guidance regarding the use of re-operation rates in the re-validation of UK based orthopaedic surgeons. Currently, little has been published concerning acceptable rates of re-operation following primary surgical management of orthopaedic trauma, particularly with reference to re-validation. We conducted a retrospective review of patients undergoing a clearly defined re-operation following primary surgical management of trauma between 1. st. January 2010 and 31. st. December 2011. 3688 patients underwent primary procedures while 83 (2.25%; 99%CI = 1.69 to 2.96%) required an unplanned re-operation. The mean age of patients was 46 years (range 2–98) with 46 (55%) males and a median time to re-operation of 34 days (IQR 12–134). Potentially avoidable re-operations occurred in 47 patients (56.6%; 99%CI = 42.6 to 69.8%) largely due to technical errors (46 patients; 55.4%; 99%CI = 41.4 to 68.7%), representing 1.27% (99%CI = 0.87 to 1.83%) of the total trauma workload. Within RCS guidelines 28 day re-operation rates for hip fractures, wrist fractures and ankle fractures were 1.4% (99%CI = 0.5 to 3.3%), 3.5% (99%CI = 0.8% to 12.1%) and 2.48% (99%CI = 0.7 to 7.6%) respectively. We present novel work that has established baseline re-operation rates for index procedures required for revalidation of orthopaedic surgeons

We performed a prospective audit to investigate the comparability of subjective and objective assessment scores of shoulder function following surgery for rotator cuff pathology. A consecutive series of 372 patients underwent surgery for rotator cuff disorders with post-operative follow up over 24 months. 248 patients solely underwent subacromial decompression, whereas 124 had additional rotator cuff repair (93 arthroscopic; 31 open). Assessments were made pre-operatively, and at 3, 6, 12, and 24 post-operative months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Oxford Shoulder Questionnaire (OSQ); and the Constant score, which was used as a reference. Standardisation calculations were performed to convert all scores into a 0 to 100 scale, with 100 representing a normal shoulder. The student’s t-test was used to compare the mean score for each subjective tool (DASH and OSQ) with the objective score (Constant) at each time point. Correlation coefficients (Pearson’s) were used to analyse the changes with time (post-operative course). Each statistical test was used for all surgeries collectively and for the individual surgery types. The relationship between the DASH and the Constant score was robust in all types of surgery. The relationship between the Oxford and Constant was generally robust, except in the open rotator cuff group. There was no statistical difference between the mean DASH and Constant scores for all interventions at each time point. A significant difference was seen between the mean Oxford and Constant scores for at least one time point in all but the open rotator cuff repair group. We demonstrate the DASH and Oxford scoring systems would be useful substitutes for the Constant score, obviating the need for the trained investigator and specialist equipment required to perform the Constant score, alongside the associated cost benefits. Further it provides evidence of service, aids appraisal and revalidation

Background. A recent Cochrane review has shown that total shoulder arthroplasty (TSA) seems to offer an advantage in terms of shoulder function over hemiarthroplasty, with no other obvious clinical benefits. This is the first study to compare complication rates on a national scale. Methods. All patients (9804 patients) who underwent either TSA or shoulder hemiarthroplasty as a planned procedure between 2005 and 2008 in the English NHS were identified using the hospital episodes statistic database. Data was extracted on 30-day rates of readmission, wound complications, reoperation and medical complications (myocardial infarction (MI) and chest infection (LRTI)), and inpatient 90-day DVT, PE and mortality rates (MR). Revision rate at 18 months was analysed for the whole cohort and, for a subset of 939 patients, 5-year revision rate. Odds ratio (OR) was used to compare groups. Results. Mean age was 70.6 years for the TSA group and 69.3 for hemiarthroaplasty. There were no significant differences in 30-day readmission (0.82% vs. 0.83%, OR 0.99 (95% CI 0.63–1.55)), wound complication (0.57% vs. 0.51%, OR 1.11 (0.63–1.94)), and reoperation rates (0.20% vs. 0.22%, OR 0.89 (0.36–2.19)). 18-month revision was significantly higher in the TSA groups (3.03% vs. 1.76%, OR 1.75 (1.33–2.28), but at 5-years no difference was seen (3.85% vs. 3.67%, OR 0.95 (0.46–1.91). The overall 90-day MR was 0.43% (42 patients). 0.58% had a LRTI and 0.29% had an MI. There were 13 DVTs (0.13%) and 22 PEs (0.22%, 5 fatal). Discussion. Despite concerns regarding osteolysis around the glenoid peg after TSA, revision rates at 5 years were not significantly different to hemiarthroplasty. Except for 18-month revision rates, there were no differences in any of the outcome measures in this study. Methods of national data analysis described in this study can provide benchmark values for future subspecialty revalidation

Introduction: Virtual Reality arthroscopic training systems offer the potential for improved training, assessment and evaluation of surgical skills. Of the various virtual reality arthroscopic training systems available, the main limiting factors preventing their use as a standard training tool is the lack of force feedback. No force data is available from in vivo measurements, which would serve as the basis for the development of such a system. Methodology: We attached a six axis force torque (FT) sensor to a standard arthroscopic probe while at the same time making necessary modiþcations to meet the safety and sterility requirements, and measured in vivo the forces and torques generated during various standard tasks of a routine knee arthroscopy. [The procedure was split into 11 separate tasks] A simultaneous video recording of the procedure was made and synchronized to the force torque recording by using an audio signal. A pilot study to evaluate the difference between experienced and less experienced arthroscopists was also undertaken. Results and conclusions: For comparison and evaluation purposes the vectored XY torque recording was used. Comparison between junior and senior arthroscopic surgeons was done by assessing the XY Torque distribution over time and evaluation of the graph patterns generated while performing similar tasks. Though differences can be seen, it did not show any statistical signiþcance. Successful completion of an arthroscopic procedure requires adequate visualization and gentle manipulation of instruments and tissues within the knee. The use of a force torque sensor in arthroscopic training systems will allow detection of and warn when excessive potentially damaging forces are being used. This will provide a means for improving training as well as a method of evaluation, including revalidation

There are significant differences in the methods and styles of orthopaedic surgical training between continents, all with the aim to produce competent consultant surgeons, but the differences in training content and pathway are vast. We review and contrast the key differences between three continents.

Patient-centred medicine is an approach to medical care that emphasises the patient experience. Treatment outcome measures reflect this experience, and outcomes are measured by obtaining patient feedback. Central to this type of care is the patient-physician relationship. Communication, physician empathy, and shared decision making are key components of this relationship. Patient-centred care is correlated with better patient outcomes across medical specialties and higher patient perceived quality of care. Payors are now using patient-centred quality measures in their physician reimbursement schedules.