Skills simulation is increasingly used as a training tool in postgraduate surgical training. Trainee's perception of the value of this experience has not previously been investigated. The aim of this investigation was to investigate the value of surgical simulation training delivered by an arthroscopy skills course.

We constructed a subject-specific, self-assessment questionnaire based around the ISCP Peer Assessment Tool. The questionnaire was administered to candidates before and after attending the Plymouth Arthroscopy Skills Course. Participant demographic data was recorded. Questionnaire data was interrogated to give an overview of the course, as well as the benefit of site-specific skills stations. Statistical analysis showed the data to be normally distributed. The paired T-test was used to compare mean values.

Twelve surgical trainees attended the course – CT2 trainees (n=4); ST3 trainees (n=7); ST4 trainee (n=1). 11 candidates completed both administered questionnaires giving a 92% response rate. The global mean score at the beginning of the course was 2.39. The global mean score at the end of the course was 3.90. The mean improvement was 1.51 (p<0.01; 95% CI= 0.96-2.07). Skill station specific scores all showed improvement with the greatest effect in wrist arthroscopy. CT trainees had a lower mean score compared to ST trainees. Both groups completed the course with similar mean scores.

This study shows that arthroscopy simulation improves trainee-reported ratings of surgical skill. It also shows that less experienced candidates derived the greatest benefit from the training. Further research is required to compare self-assessed performance against objective benchmarks using validated assessment tools.

Military patients have high functional requirements of the upper limb and may have lower pre-operative PROM scores than civilian patients i.e. their function is high when benchmarked, but still insufficient to perform their military role thereby mandating surgery. Our aim was to compare the pre-operative Oxford Shoulder Instability Scores in military and civilian patients undergoing shoulder stabilisation surgery.

We undertook a prospective, blinded cohort-controlled study (OCEBM Level 3b). The null hypothesis was that there was no difference in the Oxford Shoulder Instability Scores between military and civilian groups. A power calculation showed that 40 patients were required in each group to give 95% power with 5% significance. A clinical database (iParrot, ByResults Ltd., Oxford, UK) was interrogated for consecutive patients undergoing shoulder stabilisation surgery at a single centre. The senior author - blinded to the outcome score - matched patients according to age, gender and diagnosis. Statistical analysis showed the data to be normally distributed so a paired samples t-test was used to compare the two groups. 110 patients were required to provide a matched cohort of 80 patients.

There were 70 males and 10 females. Age at the time of surgery was 16-19yrs (n=6); 20-24yrs (n=28); 25-29 (n=16); 30-34(n=12); 35-49(n=12); 40-44(n=6). 72 patients (90%) had polar group one and 8 patients (10%) had polar group two instability. The mean Oxford Shoulder Instability Score in the civilian group was 17 and the in military group was 18. There was no statistical difference between the two groups (p=0.395).

This study supports the use the Oxford Shoulder Instability Score to assess military patients with shoulder instability.