Mastering the skills of orthopaedic surgery in the laboratory

“Okay, it’s time to let someone else drive now,” says Dr. Joseph DeAngelis, a fifth-year resident in orthopaedics, as he watches a first-year resident grapple with an arthroscope deeply embedded in the foot of a cadaver.

The first-year resident is learning to “drive” in the Bioskills Laboratory, on the upper floor of the Health Center’s New England Musculoskeletal Institute. This is where physicians specializing in orthopaedics can learn the rules of the road in their field without doing harm to a living patient.

The “steering wheel” in this case is an arthroscope – a flexible fiberoptic scope, the size of a long drinking straw, fitted with a miniature camera, a light source, and precision tools. It has become a primary tool of the trade for an orthopaedist – used both for diagnostic procedures and for a wide range of surgical repairs.

Gaining skill, alleviating anxiety
“The first day, we were unfamiliar with the equipment and weren’t really sure what to do,” says Dr. Andrew Ritting, a first year orthopaedic resident.

“You don’t want to start your second year of residency and be on a scope service and never have seen or held a scope before. The more time we spend here in the bioskills lab, the more it helps alleviate some of the anxiety.” And Ritting will spend plenty of time here – approximately 250 hours during his five-year post-graduate residency program.

Learning to master the arthroscope is critical to the success of an orthopaedic surgeon and, unless you’re a whiz at video games, it’s much harder than you would think.

The lab is equipped with six operating stations and full-size plasma screen monitors capable of projecting both the procedures underway in the lab and actual surgical procedures in the operating room suites two floors below.

“The lab is divided into stations, and we run it almost like an athletic practice,” says Dr. Augustus Mazzocca, an orthopaedic surgeon, an active team physician for the UConn athletic teams, and director of the bioskills lab.

At one station, for example, second-year residents are practicing with the scope on the shoulders of a cadaver. At another station, third-year residents are working on subacromial decompressions, the surgical treatment for shoulder bursitis. And at a third, the fifth-year residents are doing rotator cuff repair.

“Every year they continue building on their skills, so when they get into the Operating Room, they have a better understanding of the procedure and will be able to assist the surgeon more effectively,” says Mazzocca.

Dr. Kate Doughty, a fourth-year orthopaedic resident, says, “It’s daunting to be faced with a living patient and be expected to use the scope. Practice in the lab gives us a level of comfort and confidence that we would not have otherwise.”