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Papers by silvio ndoja

Research paper thumbnail of Orthopedic surgeons’ transition into full-time practice over the last 20 years: an analysis using Ministry of Health billing data

Canadian journal of surgery, Apr 26, 2024

Research paper thumbnail of <p>Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems</p>

Orthopedic research and reviews, Sep 1, 2020

Research paper thumbnail of Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up

Journal of Arthroplasty, 2020

Research paper thumbnail of Fundamental trends within falling match rates: insights from the past decade of Canadian residency matching data

Canadian medical education journal, Apr 20, 2020

Research paper thumbnail of Active Retrieval Improves Procedural Learning in Orthopedic Surgery

Journal of Surgical Education, Sep 1, 2022

Research paper thumbnail of The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: Results from multiple samplings of a single cohort

Research Square (Research Square), Oct 28, 2020

Background: Medicine is a eld that is simultaneously factual and ambiguous. Medical students have... more Background: Medicine is a eld that is simultaneously factual and ambiguous. Medical students have their rst exposure to full time clinical practice during clerkship. While studies have examined medical trainees' tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students. Methods: This was a multiple sampling, single cohort study of students in their rst year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their rst (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via ttests. Results: From a total possible sample of 174 clinical clerkship students, 51 students responded to presurvey, 62 responded to post-survey. Clerkship was associated with a signi cant decrease in TOA (p<0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not signi cantly different over time (p>0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r=0.32) that increased slightly after clerkship (r=0.39). Those preferring primary care specialties had signi cantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship. Conclusion: Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. We discuss these ndings in the context of an underlying anxiety cycle related to frequent rotation changes. Implications of the role of perfectionism and primary care is discussed. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

Research paper thumbnail of The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: A study of clerkship training effects

Research Square (Research Square), Jan 23, 2020

Background: Medicine is a field that is simultaneously factual and ambiguous. While studies have ... more Background: Medicine is a field that is simultaneously factual and ambiguous. While studies have examined medical trainees' tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. Methods: This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests. Results: From a total possible sample of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p=0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p>0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r=0.32) that increased slightly after clerkship (r=0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in preclerkship than those choosing other specialties, but this difference was not found post-clerkship. Conclusion: We hypothesize that the decrease in TOA seen in this study may reflect an underlying anxiety cycle related to frequent rotation changes. Implications of the role of perfectionism and primary care is discussed. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

Research paper thumbnail of Le point de vue des patients sur le degré de participation des résidents en salle d’opération dans le cas d’une arthroplastie totale de la hanche ou du genou

Introduction: Previous work suggests that patients do not understand the extent of trainee involv... more Introduction: Previous work suggests that patients do not understand the extent of trainee involvement in their care and are uncomfortable with trainee involvement. Methods: We recruited 202 English speaking patients with previous or planned total joint arthroplasty of the lower limb for a prospective survey trial. We assessed participant’s knowledge of trainee level of education and confidence of trainee involvement in their surgery as a function of supervision. Results: Participants’ mean level of confidence in the consultant surgeon was 4.30 (SD±1.13) on a 5-point Likert scale. Confidence in residents was significantly less, regardless of resident experience (p < 0.05). 11.1% of participants did not want trainees involved in their treatment.  60.6% would like to know more about the education level of the trainee. Less than half of participants correctly identified the education level of residents and fellows. Conclusion: Patient confidence in trainees performing part or a...

Research paper thumbnail of Three Femoral Stem Designs Without Any Corrosion Over 15 Years: A Review 0F 2095 Stems

Orthopaedic Proceedings, Oct 31, 2019

Research paper thumbnail of Cost and safety of inpatient versus outpatient open reduction internal fixation of isolated ankle fractures

Canadian Journal of Surgery

Cost and safety of inpatient versus outpatient open reduction internal fixation of isolated ankle... more Cost and safety of inpatient versus outpatient open reduction internal fixation of isolated ankle fractures Background: As health care shifts to value-based models, one strategy within orthopedics has been to transition appropriate cases to outpatient or ambulatory settings to reduce costs; however, there are limited data on the efficacy and safety of this practice for isolated ankle fractures. The purpose of this study was to compare the cost and safety associated with inpatient versus outpatient ankle open reduction internal fixation (ORIF). Methods: All patients who underwent ORIF of isolated closed ankle fractures at 2 affiliated hospitals between April 2016 and March 2017 were identified retrospectively. Demographic characteristics, including age, gender, comorbidities and injuryspecific variables, were collected. We grouped patients based on whether they underwent ankle ORIF as an inpatient or outpatient. We determined case costing for all patients and analyzed it using multivariate regression analysis. Results: A total of 196 patients (125 inpatient, 71 outpatient) were included for analy sis. Inpatients had a significantly longer mean length of stay than outpatients (54.3 h [standard deviation (SD) 36.3 h] v. 7.5 h [SD 1.7 h], p < 0.001). The average cost was significantly higher for the inpatient cohort than the outpatient cohort

Research paper thumbnail of The Institutional Burden of Ankle Fracture Surgery: A Comparison of Cost and Resource Utilization Associated with Inpatient and Outpatient Care

Orthopaedic Proceedings, Jul 24, 2020

Research paper thumbnail of Patients’ perspectives on the extent of resident participation in the operating room for total hip or knee arthroplasty

Canadian Medical Education Journal, 2020

Introduction: Previous work suggests that patients do not understand the extent of trainee involv... more Introduction: Previous work suggests that patients do not understand the extent of trainee involvement in their care and are uncomfortable with trainee involvement. Methods: We recruited 202 English speaking patients with previous or planned total joint arthroplasty of the lower limb for a prospective survey trial. We assessed participant’s knowledge of trainee level of education and confidence of trainee involvement in their surgery as a function of supervision. Results: Participants’ mean level of confidence in the consultant surgeon was 4.30 (SD±1.13) on a 5-point Likert scale. Confidence in residents was significantly less, regardless of resident experience (p < 0.05). 11.1% of participants did not want trainees involved in their treatment. 60.6% would like to know more about the education level of the trainee. Less than half of participants correctly identified the education level of residents and fellows. Conclusion: Patient confidence in trainees performing part or all of...

Research paper thumbnail of Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems

Orthopedic Research and Reviews, 2020

Research paper thumbnail of Fundamental trends within falling match rates: insights from the past decade of Canadian residency matching data

Canadian Medical Education Journal, 2020

Background: The number of unmatched Canadian Medical Graduates (CMGs) has risen dramatically over... more Background: The number of unmatched Canadian Medical Graduates (CMGs) has risen dramatically over the last decade. To identify long-term solutions to this problem, an understanding of the factors contributing to these rising unmatched rates is critical. Methods: Using match and electives data from 2009-2019, we employed machine learning algorithms to identify three clusters of disciplines with distinct trends in match and electives behaviours. We assessed the relationships between unmatched rates, competitiveness, rates of parallel planning, and program selection practices at a discipline level. Results: Across Canada, growth in CMGs has outpaced growth in residency seats, narrowing the seat-to-applicant ratio. Yet not all disciplines have been affected equally - a subset of surgical disciplines experienced a consistent decline in residency seats over time. Applicants to these disciplines are also at disproportionate risk of becoming unmatched, and this is associated with lower ra...

Research paper thumbnail of The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: A study of clerkship training effects

Background : Medicine is a field that is simultaneously factual and ambiguous. While studies have... more Background : Medicine is a field that is simultaneously factual and ambiguous. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with other psychological factors such as perfectionism is unknown. Methods: This was a single cohort study:174 Students in the first (pre) and last (post) 12 weeks of their 3 rd year comprising of 6 core rotations were invited to participate in an online anonymous survey. The survey included demographic information along with published and validated TOA and perfectionism scales. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons and correlations were used to detect the effect of clerkship on TOA, perfectionism and their relationship. Results: 51 students responded to pre-survey, 62 responded to post-s...

Research paper thumbnail of Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up

The Journal of Arthroplasty, 2019

Background: There is controversy regarding the superiority of posterior-stabilizing (PS) total kn... more Background: There is controversy regarding the superiority of posterior-stabilizing (PS) total knee arthroplasty (TKA) and cruciate-retaining (CR) TKA. Substantial work has made comparisons between PS and CR TKA at follow-ups of less than 5 years. It was the goal of the present study to compare the kinematics at greater than 5 years postoperatively between CR and PS TKA, with a secondary goal of comparing patient function. Methods: A total of 42 knees were investigated, with equal representation in the PS and CR TKA groups. Patients underwent radiostereometric analysis imaging at 0 , 20 , 40 , 60 80 , and 100 of flexion. Contact position, magnitude of excursion, and condylar separation on each condyle were measured. A Timed-Up-and-Go functional test was also performed by patients, with the total test time being measured. Preoperative and postoperative clinical outcome scores were also collected. Results: There were differences in contact position on both the medial and lateral condyles at multiple angles of flexion (P < .05). There was no difference (P ¼ .89) in medial excursion; however, PS TKA had greater lateral excursion than CR TKA (P < .01). No difference (P > .99) was found in frequency of condylar separation. PS TKA was associated with faster (P ¼ .03) total Timed-Up-and-Go test times. There were no differences in clinical outcome scores between the groups preoperatively or postoperatively. Conclusion: We found kinematic and functional differences that favor PS TKA. Our results suggest posterior cruciate ligament insufficiency in CR TKA, indicating that perhaps the cam/post systems in PS TKA better maintain knee kinematics and function long term.

Research paper thumbnail of Active Retrieval Improves Procedural Learning in Orthopedic Surgery

Journal of Surgical Education

Research paper thumbnail of Orthopedic surgeons’ transition into full-time practice over the last 20 years: an analysis using Ministry of Health billing data

Canadian journal of surgery, Apr 26, 2024

Research paper thumbnail of <p>Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems</p>

Orthopedic research and reviews, Sep 1, 2020

Research paper thumbnail of Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up

Journal of Arthroplasty, 2020

Research paper thumbnail of Fundamental trends within falling match rates: insights from the past decade of Canadian residency matching data

Canadian medical education journal, Apr 20, 2020

Research paper thumbnail of Active Retrieval Improves Procedural Learning in Orthopedic Surgery

Journal of Surgical Education, Sep 1, 2022

Research paper thumbnail of The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: Results from multiple samplings of a single cohort

Research Square (Research Square), Oct 28, 2020

Background: Medicine is a eld that is simultaneously factual and ambiguous. Medical students have... more Background: Medicine is a eld that is simultaneously factual and ambiguous. Medical students have their rst exposure to full time clinical practice during clerkship. While studies have examined medical trainees' tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students. Methods: This was a multiple sampling, single cohort study of students in their rst year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their rst (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via ttests. Results: From a total possible sample of 174 clinical clerkship students, 51 students responded to presurvey, 62 responded to post-survey. Clerkship was associated with a signi cant decrease in TOA (p<0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not signi cantly different over time (p>0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r=0.32) that increased slightly after clerkship (r=0.39). Those preferring primary care specialties had signi cantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship. Conclusion: Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. We discuss these ndings in the context of an underlying anxiety cycle related to frequent rotation changes. Implications of the role of perfectionism and primary care is discussed. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

Research paper thumbnail of The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: A study of clerkship training effects

Research Square (Research Square), Jan 23, 2020

Background: Medicine is a field that is simultaneously factual and ambiguous. While studies have ... more Background: Medicine is a field that is simultaneously factual and ambiguous. While studies have examined medical trainees' tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. Methods: This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests. Results: From a total possible sample of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p=0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p>0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r=0.32) that increased slightly after clerkship (r=0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in preclerkship than those choosing other specialties, but this difference was not found post-clerkship. Conclusion: We hypothesize that the decrease in TOA seen in this study may reflect an underlying anxiety cycle related to frequent rotation changes. Implications of the role of perfectionism and primary care is discussed. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

Research paper thumbnail of Le point de vue des patients sur le degré de participation des résidents en salle d’opération dans le cas d’une arthroplastie totale de la hanche ou du genou

Introduction: Previous work suggests that patients do not understand the extent of trainee involv... more Introduction: Previous work suggests that patients do not understand the extent of trainee involvement in their care and are uncomfortable with trainee involvement. Methods: We recruited 202 English speaking patients with previous or planned total joint arthroplasty of the lower limb for a prospective survey trial. We assessed participant’s knowledge of trainee level of education and confidence of trainee involvement in their surgery as a function of supervision. Results: Participants’ mean level of confidence in the consultant surgeon was 4.30 (SD±1.13) on a 5-point Likert scale. Confidence in residents was significantly less, regardless of resident experience (p < 0.05). 11.1% of participants did not want trainees involved in their treatment.  60.6% would like to know more about the education level of the trainee. Less than half of participants correctly identified the education level of residents and fellows. Conclusion: Patient confidence in trainees performing part or a...

Research paper thumbnail of Three Femoral Stem Designs Without Any Corrosion Over 15 Years: A Review 0F 2095 Stems

Orthopaedic Proceedings, Oct 31, 2019

Research paper thumbnail of Cost and safety of inpatient versus outpatient open reduction internal fixation of isolated ankle fractures

Canadian Journal of Surgery

Cost and safety of inpatient versus outpatient open reduction internal fixation of isolated ankle... more Cost and safety of inpatient versus outpatient open reduction internal fixation of isolated ankle fractures Background: As health care shifts to value-based models, one strategy within orthopedics has been to transition appropriate cases to outpatient or ambulatory settings to reduce costs; however, there are limited data on the efficacy and safety of this practice for isolated ankle fractures. The purpose of this study was to compare the cost and safety associated with inpatient versus outpatient ankle open reduction internal fixation (ORIF). Methods: All patients who underwent ORIF of isolated closed ankle fractures at 2 affiliated hospitals between April 2016 and March 2017 were identified retrospectively. Demographic characteristics, including age, gender, comorbidities and injuryspecific variables, were collected. We grouped patients based on whether they underwent ankle ORIF as an inpatient or outpatient. We determined case costing for all patients and analyzed it using multivariate regression analysis. Results: A total of 196 patients (125 inpatient, 71 outpatient) were included for analy sis. Inpatients had a significantly longer mean length of stay than outpatients (54.3 h [standard deviation (SD) 36.3 h] v. 7.5 h [SD 1.7 h], p < 0.001). The average cost was significantly higher for the inpatient cohort than the outpatient cohort

Research paper thumbnail of The Institutional Burden of Ankle Fracture Surgery: A Comparison of Cost and Resource Utilization Associated with Inpatient and Outpatient Care

Orthopaedic Proceedings, Jul 24, 2020

Research paper thumbnail of Patients’ perspectives on the extent of resident participation in the operating room for total hip or knee arthroplasty

Canadian Medical Education Journal, 2020

Introduction: Previous work suggests that patients do not understand the extent of trainee involv... more Introduction: Previous work suggests that patients do not understand the extent of trainee involvement in their care and are uncomfortable with trainee involvement. Methods: We recruited 202 English speaking patients with previous or planned total joint arthroplasty of the lower limb for a prospective survey trial. We assessed participant’s knowledge of trainee level of education and confidence of trainee involvement in their surgery as a function of supervision. Results: Participants’ mean level of confidence in the consultant surgeon was 4.30 (SD±1.13) on a 5-point Likert scale. Confidence in residents was significantly less, regardless of resident experience (p < 0.05). 11.1% of participants did not want trainees involved in their treatment. 60.6% would like to know more about the education level of the trainee. Less than half of participants correctly identified the education level of residents and fellows. Conclusion: Patient confidence in trainees performing part or all of...

Research paper thumbnail of Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems

Orthopedic Research and Reviews, 2020

Research paper thumbnail of Fundamental trends within falling match rates: insights from the past decade of Canadian residency matching data

Canadian Medical Education Journal, 2020

Background: The number of unmatched Canadian Medical Graduates (CMGs) has risen dramatically over... more Background: The number of unmatched Canadian Medical Graduates (CMGs) has risen dramatically over the last decade. To identify long-term solutions to this problem, an understanding of the factors contributing to these rising unmatched rates is critical. Methods: Using match and electives data from 2009-2019, we employed machine learning algorithms to identify three clusters of disciplines with distinct trends in match and electives behaviours. We assessed the relationships between unmatched rates, competitiveness, rates of parallel planning, and program selection practices at a discipline level. Results: Across Canada, growth in CMGs has outpaced growth in residency seats, narrowing the seat-to-applicant ratio. Yet not all disciplines have been affected equally - a subset of surgical disciplines experienced a consistent decline in residency seats over time. Applicants to these disciplines are also at disproportionate risk of becoming unmatched, and this is associated with lower ra...

Research paper thumbnail of The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: A study of clerkship training effects

Background : Medicine is a field that is simultaneously factual and ambiguous. While studies have... more Background : Medicine is a field that is simultaneously factual and ambiguous. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with other psychological factors such as perfectionism is unknown. Methods: This was a single cohort study:174 Students in the first (pre) and last (post) 12 weeks of their 3 rd year comprising of 6 core rotations were invited to participate in an online anonymous survey. The survey included demographic information along with published and validated TOA and perfectionism scales. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons and correlations were used to detect the effect of clerkship on TOA, perfectionism and their relationship. Results: 51 students responded to pre-survey, 62 responded to post-s...

Research paper thumbnail of Comparison of Contact Kinematics in Posterior-Stabilized and Cruciate-Retaining Total Knee Arthroplasty at Long-Term Follow-Up

The Journal of Arthroplasty, 2019

Background: There is controversy regarding the superiority of posterior-stabilizing (PS) total kn... more Background: There is controversy regarding the superiority of posterior-stabilizing (PS) total knee arthroplasty (TKA) and cruciate-retaining (CR) TKA. Substantial work has made comparisons between PS and CR TKA at follow-ups of less than 5 years. It was the goal of the present study to compare the kinematics at greater than 5 years postoperatively between CR and PS TKA, with a secondary goal of comparing patient function. Methods: A total of 42 knees were investigated, with equal representation in the PS and CR TKA groups. Patients underwent radiostereometric analysis imaging at 0 , 20 , 40 , 60 80 , and 100 of flexion. Contact position, magnitude of excursion, and condylar separation on each condyle were measured. A Timed-Up-and-Go functional test was also performed by patients, with the total test time being measured. Preoperative and postoperative clinical outcome scores were also collected. Results: There were differences in contact position on both the medial and lateral condyles at multiple angles of flexion (P < .05). There was no difference (P ¼ .89) in medial excursion; however, PS TKA had greater lateral excursion than CR TKA (P < .01). No difference (P > .99) was found in frequency of condylar separation. PS TKA was associated with faster (P ¼ .03) total Timed-Up-and-Go test times. There were no differences in clinical outcome scores between the groups preoperatively or postoperatively. Conclusion: We found kinematic and functional differences that favor PS TKA. Our results suggest posterior cruciate ligament insufficiency in CR TKA, indicating that perhaps the cam/post systems in PS TKA better maintain knee kinematics and function long term.

Research paper thumbnail of Active Retrieval Improves Procedural Learning in Orthopedic Surgery

Journal of Surgical Education