Cadaveric simulation versus standard training for postgraduate trauma and orthopaedic surgical trainees: protocol for the CAD:TRAUMA study multicentre randomised controlled educational trial

Abstract

IntroductionThe quantity and quality of surgical training in the UK has been negatively affected by reduced working hours and National Health Service (NHS) financial pressures. Traditionally surgical training has occurred by the master-apprentice model involving a process of graduated responsibility, but a modern alternative is to use simulation for the early stages of training. It is not known if simulation training for junior trainees can safeguard patients and improve clinical outcomes. This paper details the protocol for a multicentre randomised controlled educational trial of a cadaveric simulation training intervention versus standard training for junior postgraduate orthopaedic surgeons-in-training. This is the first study to assess the effect of cadaveric simulation training for open surgery on patient outcome. The feasibility of delivering cadaveric training, use of radiographic and clinical outcome measures to assess impact and the challenges of upscaling provision will be explored.Methods and analysisWe will recruit postgraduate orthopaedic surgeons-in-training in the first 3 years (of 8) of the specialist training programme. Participants will be block randomised and allocated to either cadaveric simulation or standard ‘on-the-job’ training, learning three common orthopaedic procedures, each of which is a substudy within the trial. The procedures are (1) dynamic hip screw, (2) hemiarthroplasty and (3) ankle fracture fixation. These procedures have been selected as they are very common procedures which are routinely performed by junior surgeons-in-training. A pragmatic approach to sample size is taken in lieu of a formal power calculation as this is novel exploratory work with no a priori estimate of effect size to reference. The primary outcome measure is the technical success of the surgery performed on patients by the participating surgeons-in-training during the follow-up period for the three substudy procedures, as measured by the implant position on the postoperative radiograph. The secondary outcome measures are procedure time, postoperative complication rate and patient health state at 4 months postoperation (EQ-5D—substudies 1 and 2 only).Ethics, registration and disseminationNational research ethics approval was granted for this study by the NHS Research Authority South Birmingham Research Ethics Committee (15/WM/0464). Confidentiality Advisory Group approval was granted for accessing radiographic and outcome data without patient consent on 27 February 2017 (16/CAG/0125). The results of this trial will be submitted to a peer-reviewed journal and will inform educational and clinical practice.Trial registration numberISRCTN20431944

Utility of the Simulated Outcomes Following Carotid Artery Laceration Video Data Set for Machine Learning Applications

“…These cadaveric simulations allowed surgeons to hone their skills and receive feedback in a highly realistic, structured environment without risking patient harm. 28 , 29 , 30 …”

“…Video of these scenarios often contains bleeding that can obscure the entire surgical scene. These cadaveric simulations allowed surgeons to hone their skills and receive feedback in a highly realistic, structured environment without risking patient harm …”

Development of the McMaster Embalming Scale (MES) to assess embalming solutions for surgical skills training

“…Practicing on simulation models with functional task alignment is imperative to surgical skills training. This study enhanced the current knowledge regarding tissue preservation solutions for surgical procedures by creating a validated scale that evaluates the effectiveness of different embalming solutions for various surgical skills (Curran, 2011; James et al, 2020).…”

“…The cadavers investigated by the included studies were embalmed using various soft‐preservation and hard‐fixation techniques, many of which were not reported in detail. As such, the utility of cadaveric simulation‐based training could have been affected by the tissue fixation used (James et al, 2020).…”

Einsatz von vorfrakturierten Präparaten für die Weiterbildung in Orthopädie und Unfallchirurgie

“…Dennoch deuten zahlreiche Hinweise darauf hin, dass innovative Aus- und Weiterbildungskonzepte neben der innerklinischen Ausbildung notwendig sind, um eine Patientenversorgung auf Spitzenniveau und gleichzeitige Kosteneffizienz weiterhin zu gewährleisten 1 , 9 , 10 . Eine aktuell registrierte Multicenterstudie vergleicht die Ergebnisqualität von definierten Operationen (dynamische Hüftschraube, Hüftprothese und Sprunggelenksfraktur), die von unfallchirurgischen und orthopädischen Jungassistenten*innen ausgeführt werden 11 . Die Assistenten*innen erhalten entweder die klassische hausinterne Ausbildung oder nehmen zusätzlich an Simulationskursen mit Humanpräparaten teil.…”