The Cigar Box Arthroscopy modules were developed in response to the mandate by the Resident Review Committee that all orthopedic surgery residency programs in the United States provide surgical skills training during the first post graduate year. In seeking to provide this training, we found that most systems cost several hundreds of dollars and required additional purchases for upkeep. Furthermore, once these systems were purchased, specific instructional protocols would need to be written by each program to ensure residents received appropriate training.
Facing our own budgetary constraints, we developed a non-anatomic and self-guided series of modules built within cigar boxes and based on the principles of the FAST system. The overall goal was to create a system that instructed the residents in: a basic knee arthroscopy exam, chondroplasty, menisectomy, and microfracture. Cigar boxes were chosen because they are durable, sealed from nearly all light when closed, allowed an easy open top for 3D conceptualization, and were free to acquire from local businesses. The total cost of construction was $44.12. The design, construction, and testing occurred over a one year period, working part time. We then performed a randomized controlled trial with blinded evaluators assessing performance of medical students on cadavers. They were randomized to receive previous training using our system, another validated (albeit more expensive) trainer, or text reading only. Our results showed that the subjects using the Cigar Box Arthroscopy Trainer were equally successful at obtaining a pre-determined level of minimum proficiency compared to those who trained on the other system. Both groups demonstrated higher success rates than the control group.
Recognizing that other programs may similarly be in need of a high value arthroscopy training program to comply with the mandate, we have decided to make the plans and protocols available for all to use at no cost. While the specifics of the modules (i.e. the names of items in the boxes) may need to be adapted to the boxes each program constructs, the six protocols should essentially be interchangeable or at least provide a foundation to a stepwise, self-guided system.