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Purpose: As developing arthroscopic skills is challenging and training time for residents is limited, arthroscopic skill competency of residents should be measured. Assessment tools, such as Global Rating Scales (GRS), have been developed for structured, objective feedback and to assess learning curves. The goal of this study is to assess known-groups and convergent validity of these scales, to evaluate the suitability of these scales to monitor training progress of residents. Methods: Knee arthroscopies and ACL reconstructions performed by residents were supervised and assessed, using both GRS questionnaires. The estimates of the parameters were used to study the relationship between year of residency and each GRS score, and between the number of previously performed arthroscopies and each GRS score. Pearson correlation coefficient between GRS scores were calculated to measure convergent validity. A BlandAltman plot with a paired t-test was constructed to evaluate the agreement between GRS I and II. Results: Mixed model analysis revealed a significant increase (p < 0.001) per year of residency on both GRSs (8.1 points (95% CI: 6.3-9.9) and 9.2 points (95% CI: 7.4-11.2) respectively). Significant increases per performed arthroscopy were also observed for both GRSs (p < 0.001) (0.14 (95% CI: 0.09-0.18) and 0.13 points (95% CI: 0.08-0.2) respectively). Scores for ACL reconstructions were significantly lower (p < 0.001) than for standard knee arthroscopies (12.5 and 13.0 points respectively, p < 0.001). The Pearson correlation coefficient between GRS I and GRS II scores was high (0.94). The Limit of Agreement was 11 points. Conclusion: GRS I and GRS II demonstrate sufficient construct validity. However, they seem not sufficiently sensitive and consistent to establish individual learning curves. Both scales are suitable to objectively evaluate global progress of residents in the operating room when acquiring arthroscopic skills, in particular on group level.

The Suitability of Global Rating Scales to Monitor Arthroscopic Training Progress