A Cadaver-Based Course for Humanitarian Surgery Improves Manual Skill in Powerless External Fixation.

ABSTRACT

BACKGROUND: General surgery residents interested in humanitarian careers may benefit from supplemental training beyond modern residency. The Colorado Humanitarian Surgical Skills Workshop is a 2-d cadaver-based course for senior surgical residents, teaching low-resource skills across multiple specialties, including orthopedics. We assessed the course's ability to transmit manual competence in a critical humanitarian surgical skill, powerless lower extremity external fixation. MATERIALS AND METHODS: We created a novel standardized manual skills test of powerless lower extremity external fixation. Course participants had no prior experience with this technique. At course initiation, paired participants attempted to stabilize a proximal tibia-fibula fracture in a cadaver. Subsequently, participants received didactics from orthopedic surgeons followed by hands-on practice. At course completion, paired participants repeated the exercise. Fixator constructs were scored using standardized criteria. Precourse and postcourse surveys measured participants' level of confidence in performing external fixation. RESULTS: Twelve senior surgical residents were included. Average scores of external fixator constructs improved significantly (23% pre versus 75% post, P < 0.01). On pretesting, none of the participants completed the exercise within 15 min. Only one of six constructs was marginally stable, and none were aligned. On post-testing, five of six teams completed the exercise in an average of 12.4 min. Four of six constructs were stable and two of six were also well aligned. Confidence with external fixation also improved significantly. CONCLUSIONS: Participants in a short cadaver-based workshop demonstrated significant improvements in manual skill and confidence related to powerless external fixation. However, additional training is likely required to achieve clinical competence.