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A Comparison C1–C2 Transarticular Screw Placement After Self‐Education and Mentored Education of Orthopaedic Residents

Study Design: Prospective randomized trial. Objective: This study will provide preliminary data on whether residents can be “self‐taught” and to what extent a lecture, demonstration, and coaching can improve skills and knowledge. Background Data: Practice‐based learning is an essential competency in Accreditation Council for graduate Medical Education‐accredited residencies. Little has been done to demonstrate whether residents can be self‐taught or benefit from mentoring in understanding and performing difficult surgical tasks. Methods: A written test was given to orthopedic residents on C1–C2 transarticular screw placement. They were then provided reading on C1–C2 transarticular screw placement. Residents were then divided into a “self‐directed learning” group and a “mentored learning” group. All residents then performed the technique on models, with the “mentored” group receiving a lecture and coaching from the mentor. The models were analyzed for technique errors and the previous test was administered again as a posttest. The test and screw placement were repeated 4 months later. Results: Residents without mentoring had an average improvement of 4.5 points, those with mentoring had average improvement of 8.6 points (P=0.0068). The screw placement technique error rate for the nonmentored group (n=8) was 2.55, and for the mentored group (n=9) was 1.47 (P=0.004). Sixteen residents completed the delayed test, 7 from the nonmentored groups and 8 from the mentored group. Nine residents were able to repeat the screw placement technique 4 months after the initial test and screw placement, 3 nonentored, and 6 mentored. Although there were some trends toward the mentored group having better retention, neither knowledge nor skill was statistically different. Conclusions: This preliminary trial seems to indicate that residents provided a lecture and guided technical instruction will obtain knowledge and perform procedures better than those that do not. Conclusions based upon Post Graduate year, motivation, and interest in spine surgery could not be made.