High-Fidelity Wrist Fracture Phantom as a Training Tool to Develop Competency in Orthopaedic Surgical Trainees

Abstract

Background: This article will describe the development of a low-cost 3D-printed medical phantom of the arm with a distal radius fracture (DRF) to facilitate training of reduction and splinting techniques. The phantom incorporates tactile responses and visual stimuli from fluoroscopy to assist skill acquisition in a clinical setting. This provides feedback to trainees to help them develop competency and knowledge before providing care to patients. Methods: Phantoms were developed through advice and feedback from fellowship-trained hand surgeons and orthopaedic senior and junior residents. Phantoms were then pilot tested during a surgical skills examination, with residents having minimal previous exposure to distal radial reduction techniques. Residents were evaluated on procedure speed and accuracy by attending surgeons using the objective structured assessment of technical skills. Residents then completed a written knowledge examination about relevant requirements of DRF management and feedback on their opinion of the exercise using the Likert scale. Results: Residents who passed the hands-on examination also scored higher on the written examination. All residents reported that the phantom was beneficial and motivating as part of their overall training. Discussion: Real-time feedback using a phantom limb and fluoroscopic imaging, in conjunction with guidance from surgeons, allows residents to learn and practice DRF reduction and splinting techniques. These educational exercises are relatively low-cost and remove the risk of potential harm to patients during early skill acquisition. This training method may be a predictor of surgical performance in addition to providing assessment of background knowledge. Additional training sessions will be required to determine the effect of repeat exposure to residents' proficiency and comprehension.

3D Printing of Customizable Phantoms to Replace Cadaveric Models in Upper Extremity Surgical Residency Training

“…Introducing anatomical features and surgical practices in medical education often relies on cadaveric tissue samples to provide hands-on experience; however, they are not a perfect substitute for live tissue [1]. Tissue degradation occurs shortly after death, and preservative chemicals also introduce changes to the mechanical properties of the sample.…”

“…Cadaveric models are often single-use due to added degradation from the training procedure, and large-volume training remains limited by high procurement and on-site refrigerated storage costs [2]. Medical phantoms utilize synthetic materials to replicate the hard and soft tissue mechanical behavior of live persons, allowing for customized models displaying specific features required for the execution of surgical techniques [1,3]. For the orthopedic upper extremity phantoms presented here, perfectly copying all human anatomy would be unnecessary and wasteful; only the anatomical features relevant to a specified training procedure should be included.…”

“…For the orthopedic upper extremity phantoms presented here, perfectly copying all human anatomy would be unnecessary and wasteful; only the anatomical features relevant to a specified training procedure should be included. This simplifies manufacturing and improves stimuli recognition and retention in novice trainees [3], including visual, tactile, and auditory sensations used to guide the application of care [1,4].…”

“…Variations across multiple training sessions could result in students missing relevant features or misidentifying cues that should not be present, resulting in confirmation bias which can blunt long-term performance [6]. "Practice is a positive constructive process if and only if that practice is an adequate substitute for the true task" [1]: poor practice produces poor performance. Patient care will always present inherent challenges but enabling residents to develop these skills earlier improves their ability to acquire future skills, improving care and limiting potential unintended harm [7][8][9].…”

“…Any model used to demonstrate this procedure must exhibit behavior sufficient to replicate that of a live patient. We do not know of any low-cost commercial DRF models with sufficient features, as described by practicing surgeons, to train orthopedic residency students [1,10]. Existing models share many common characteristics such as oversimplified soft tissues, a narrow focus on distal behavior without considering interoperative proximal features, and generic casting or splinting.…”