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Ponseti Clubfoot Casting: Factors That Affect Trainee Competency (Retrospective Observational Study)
Samuel O Noonan1, Scott Hetzel, Kenneth J Noonan
1From the University of Denver, Denver, Colorado (Noonan); the Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Bae and Dr. Shore); the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD (Dr. Herzenberg); and the University of Wisconsin School of Medicine and Public Health, Madison WI (Dr. Hetzel, Dr. Noonan).
Previous simulation training and clinical experience, including applying clubfoot casts and performing Achilles tenotomies, significantly improve orthopedic trainee performance in Ponseti method skills competitions.
Area of Science:
- Orthopaedic Surgery
- Medical Simulation
- Pediatric Orthopaedics
Background:
- The Ponseti method is a standard treatment for clubfoot.
- Assessing proficiency in the Ponseti method is crucial for effective patient care.
- Simulation-based training offers a controlled environment for skill development.
Purpose of the Study:
- To evaluate the impact of prior simulation training and clinical experience on orthopedic trainees' performance in Ponseti method procedures.
- To identify specific experiences that correlate with higher proficiency in clubfoot manipulation, casting, and tenotomy.
Main Methods:
- Sixty-four orthopedic trainees participated in a skills competition assessing clubfoot manipulation, casting, and simulated Achilles tenotomy (TAT).
- Expert surgeons judged trainee performance, and scores were analyzed against previous training and experience.
- Statistical analysis correlated performance scores with variables such as prior synthetic model training, number of casts applied, and TATs performed.
Main Results:
- Trainees with prior residency training on synthetic clubfoot models scored significantly higher (P = 0.007).
- Experience with more than 10 clubfoot casts (P = 0.038) and more than 10 TATs (P = 0.01) correlated with improved scores.
- Attendance at specialized workshops (International Pediatric Orthopaedic Symposium, P = 0.012; American Academy of Orthopaedic Surgery, P = 0.017) also showed higher performance.
Conclusions:
- Clinical and simulation experience with the Ponseti method directly correlates with improved performance in simulated scenarios.
- Higher numbers of performed clubfoot casts and Achilles tenotomies in training lead to better outcomes in skills assessments.
- Targeted training and workshops enhance proficiency in essential clubfoot management techniques.
