Impact of Simulation Training on Diagnostic Arthroscopy Performance: A Randomized Controlled Trial

Abstract

Purpose:To determine the impact of training on a virtual reality arthroscopy simulator on both simulator and cadaveric performance in novice trainees. Methods: A randomized controlled trial of 28 participants without prior arthroscopic experience was conducted. All participants received a demonstration of how to use the ArthroVision Virtual Reality Simulator and were then randomized to receive either no training (control group, n ¼ 14) or a fixed protocol of simulation training (n ¼ 14). All participants took a pretest on the simulator, completing 9 tasks ranging from camera-steadying tasks to probing structures. The training group then trained on the simulator (1 time per week for 3 weeks). At week 4, all participants completed a 2-part post-test, including (1) performing all tasks on the simulator and (2) performing a diagnostic arthroscopy on a cadaveric knee and shoulder. An independent, blinded observer assessed the performance on diagnostic arthroscopy using the Arthroscopic Surgical Skill Evaluation Tool scale. To compare differences between nonenormally distributed groups, the Mann-Whitney U test was used. An independent-samples t test was used for normally distributed groups. The Friedman test with pair-wise comparisons using Bonferroni correction was used to compare scores within groups at multiple time points. Bonferroni adjustment was applied as a multiplier to the P value; thus, the a level remained consistent. Significance was defined as P < .05. Results: In both groups, all tasks except task 5 (in which completion time was relatively fixed) showed a significant degree of correlation between task completion time and other task-specific metrics. A significant difference between the trained and control groups was found for post-test task completion time scores for all tasks. Qualitative analysis of box plots showed minimal change after 3 trials for most tasks in the training group. There was no statistical correlation between the performance on diagnostic arthroscopy on either the knee or shoulder and simulation training, with no difference in Arthroscopic Surgical Skill Evaluation Tool scores in the training group compared with controls. Conclusions: Our study suggests that an early ceiling effect is shown on the evaluated arthroscopic simulator model and that additional training past the point of proficiency on modern arthroscopic simulator models does not provide additional transferable benefits on a cadaveric model. Level of Evidence: Level I, randomized controlled trial.G raduate medical education, specifically surgical education, has traditionally been rooted in an apprenticeship model. The "see one, do one, teach one" approach has guided education in the operating room and has led to the development of surgical education as it stands today. However, there are rising concerns regarding burnoutda condition correlated with longer work hours, a skewed work-life balance, and

Practicing Procedural Skills Is More Effective Than Basic Psychomotor Training in Knee Arthroscopy: A Randomized Study

“…It would be interesting to compare the low-fidelity simulator box–trained group with a group spending the same amount of time training on more complex procedure-specific tasks. Our results, however, were comparable with the results of Wang et al, 34 who found that 3 sessions of basic psychomotor skills training on a computer-assisted arthroscopy simulator resulted in improved performance in the same skills as compared with no training but not in better performance of diagnostic arthroscopies of knee and shoulder joints on a cadaver. This indicates that there might be limited transfer of skills from training fractionated tasks 29 to whole-procedure tasks and among different tasks.…”

In Response to COVID-19: Current Trends in Orthopaedic Surgery Sports Medicine Fellowships

“…While there is some debate in the literature on the degree of transferability of skills acquired in haptics trainers and dry simulators to cadaveric and live arthroscopy, the continued advances in simulation may become more valuable as the technology advances. 5 , 6 , 13 Additionally, because of the need for social distancing, regular didactic sessions are now being held remotely via a virtual platform or not at all. In-person meetings have been the staple of medical education.…”

Use of virtual reality simulation in surgical training: a systematic review on predictive validity and current use in surgical curricula

“…Despite this, limitations include the limited number of available specimens and durability of tissue, including change in tissue tension and lack of biological feedback. Two studies found no significant difference in performance between simulated groups and the control; 22,23 the other four demonstrated improved metrics for VR-trained participants. 38,40,43,44 Nemani et al 40 compared the use of VR training with a Fundamentals of Laparoscopic Surgery (FLS) module against a previously established simulation curriculum in the final assessment using cadaver tissue.…”

“…Ten studies used a predetermined time for the VR simulation arm. 22,23,26,30,31,35,40,41,43,44 Eleven studies used a proficiency-based model. 20,21,24,25,[32][33][34]37,39,42 One study did not specify the method used.…”

“…20,21,24,25,[32][33][34]37,39,42 One study did not specify the method used. 38 Operations Six studies 22,23,26,39,43,44 used arthroscopic procedures in the final assessment. Twelve 21,24,25,27,[29][30][31][32]35,36,41,42 post-test procedures were laparoscopic, with two endovascular assessments, 28,34 one endoscopic sinus procedure, 37 and two procedures involving the eye.…”