A Randomized Controlled Pilot Study of Educational Techniques in Teaching Basic Arthroscopic Skills in a LowIncome Country

Background: Little is known about how to introduce complex technologies like arthroscopy into lowincome countries. Thus, we compared low versus highresource intensive methods of teaching basic arthroscopic skills in a randomized controlled trial in Haiti. Methods: Fortyeight Haitian orthopaedic surgeons and residents attending an orthopaedic conference in Haiti were block randomized to receive instruction through a composite video (Control) or a composite video plus handson teaching with an expert visiting surgeon (Intervention). A lowfidelity surgical simulator tested visualization and triangulation skills. Participants completed a pre and posttest where the goal was to sequentially tap the most numbers in 2.5 minutes. Outcome metrics included highest tapped number, number of errors, visualization loss, and number of lookdowns.Multivariate linear regression was used to confirm randomization and compare outcomes between groups. Results: Seventyfive percent of initially randomized attendees participated with similar attrition rates between both groups. All participants who performed a pretest completed a posttest. In terms of highest tapped number, treatment and control groups significantly improved compared to pretest scores, with mean improvement of 3.2% (P=0.007) and 2.2% (P=0.03), respectively. Improvement between treatment and control groups was not statistically different (P=0.4). No statistically significant change was seen with regard to other metrics. Conclusion: We describe a protocol to introduce basic arthroscopic skills in a lowincome country using a lowresource intensive teaching method. However, this method of learning may not be optimal given the failure to improve in all outcome measures.