Surgery Resident Perceptions of the Clicker Evaluation System: A Novel Approach to Collecting and Utilizing Clinical Faculty Performance Data.

OBJECTIVE: Medical trainees often have a process in place to receive feedback from clinical faculty regarding overall performance. While there is guidance on effective methodologies for faculty to provide feedback for learners, there is a dearth of literature analyzing trainees' evaluation of faculty performance. We sought to identify an effective and anonymous method for surgery residents to evaluate clinical faculty. DESIGN: The Department of Orthopedic Surgery at Virginia Commonwealth University (VCU) Health implemented a novel process to gather annual clinical faculty performance data from residents for the purpose of program improvement starting in 2012. Specifically, residents used a web-based audience response system, also known as a "clicker" system, to evaluate faculty performance over the academic year. During the June 2018 evaluation session, residents also completed an anonymous, 9 question survey to assess the residents' perceptions regarding this clicker evaluation process. SETTING: VCU Health System, a tertiary care hospital in Richmond, Virginia. PARTICIPANTS: All 24 orthopaedic surgery residents at VCU Health participated in the evaluation process and completed the perception survey in 2018. RESULTS: Ninety-six percent (n = 23) of the residents agreed that they are able to accurately rate their attendings' performance, felt confident that their responses remained anonymous, and that their departmental chair values their opinion when evaluating their attendings' performance through the clicker process. Qualitative responses identified anonymity as a strength of the clicker process, while opportunities for improvement included refinement of questions. CONCLUSIONS: The clicker evaluation system is an effective and anonymous method for resident evaluation of clinical faculty performance in academic settings. Future steps include refinement of questions based on departmental goals for education, adoption of the clicker evaluation system by other specialties, as well as research into ways to optimize the clicker evaluation process. Additional research should be done to see if and how the clicker evaluation feedback translates into change in clinical faculty behavior.

Patellar Osteonecrosis Following Knee Arthroscopy.

Patellar osteonecrosis is a rare condition, although knee osteonecrosis has been described in the arthroplasty literature. This is the first case describing knee arthroscopy as the cause of osteonecrosis. A 50-year-old woman who was experiencing knee pain during her marathon training and singles tennis underwent knee arthroscopy for a torn medial meniscus. The result of her partial medial meniscectomy led to patellar osteonecrosis 3 months following the index procedure. Osteonecrosis of the knee has been reported in the arthroplasty and sports medicine literature following surgical intervention, usually in total knee replacement or more complex surgical operations. However, patellar osteonecrosis following knee arthroscopy has not been reported previously. Taking care of the anterior fat pad is essential to avoid disruption of important blood supply to the patella. [Orthopedics. 2019; 42(6):e552-e554.].

Infarct-associated bone sarcomas.

UNLABELLED: Sarcoma associated with bone infarct is a rare condition sparsely reported in the literature. Sixty percent of cases arise about the knee and most are malignant fibrous histiocytomas. We report 15 patients; 12 of 15 presented with a tumor around the knee. Treatment was limb salvage in seven patients, amputation in six, and biopsy alone in two. For patients without metastatic disease at presentation, the 2-year disease-free survival rate was 63% (seven of 11). Two patients received chemotherapy and both were continuously disease-free at last followup. When we combined our 15 patients with the 52 previously reported in the literature, 38 of the 67 (57%) died of their disease at an average of 19.2 months after diagnosis; 21 patients (31%) were continuously disease-free for 24 months. Of 13 patients who received chemotherapy, eight (62%) were continuously disease-free at 24 months compared with 24% (13 of 54) of those who did not receive chemotherapy. Overall, prognosis for these patients is poor, but survival in patients without metastatic disease at diagnosis approaches that of other bone sarcomas. There is a trend suggesting adjuvant chemotherapy combined with appropriate surgery may improve patient outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic study.