Simulation of Anterior Cruciate Ligament Reconstruction in a Dry Model

Dwyer, Tim; Shantz, Jesse Slade; Chahal, Jaskarndip; Wasserstein, David; Schachar, Rachel; Kulasegaram, Kulamakan; Theodoropoulos, John; Greben, Rachel

doi:10.1177/0363546515608161

Cited by 22 publications

(16 citation statements)

References 27 publications

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“…The studies were broadly split into 3 categories: studies measuring the impact of a simulation training intervention (26 studies 6 - 31 ), studies assessing the construct validity of a simulator designed for training surgeons (42 studies 32 - 73 ), and studies validating an assessment tool (37 studies 74 - 110 ) (see Appendix Tables 1 and 2, column 1). Of the included studies, 60% assessed arthroscopic skill involving the knee (34 studies) 6 , 8 , 9 , 13 , 15 , 17 , 19 , 31 - 33 , 36 , 38 , 39 , 41 , 42 , 47 , 48 , 54 - 56 , 63 , 74 , 75 , 77 - 83 , 86 , 87 , 89 , 91 , the shoulder (25 studies) 7 , 12 , 15 , 16 , 18 , 20 , 37 , 40 , 44 , 45 , 49 , 51 , 53 , 54 , 56 , 63 , 76 , 77 , 81 , 82 , 88 , 90 - 92 , 110 , the hip (3 studies) 43 , 50 , 85 , the ankle (1 study) 14 , and basic general arthroscopic skills (6 studies)…”

Section: Resultsmentioning

confidence: 99%

“…Several novel objective assessment tools have been developed and combine task-specific checklists with a global rating scale. The most promising front-runners among these are the Arthroscopic Surgical Skill Evaluation Tool (ASSET) 36 , 37 , 77 , which combines a task-specific checklist with an 8-domain global rating scale with end and middle descriptive anchors, and the Objective Structured Assessment of Technical Skills (OSATS) tool 23 , 93 (see Appendix Table 3). While the ASSET is obviously restricted to arthroscopic procedures, both have a growing body of evidence across all domains of the utility index (Table II).…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training

et al. 2020

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Background: Robust assessment of skills acquisition and surgical performance during training is vital to ensuring operative competence among orthopaedic surgeons. A move to competency-based surgical training requires the use of tools that can assess surgical skills objectively and systematically. The aim of this systematic review was to describe the evidence for the utility of assessment tools used in evaluating operative performance in trauma and orthopaedic surgical training. Methods: We performed a comprehensive literature search of MEDLINE, Embase, and Google Scholar databases to June 2019. From eligible studies we abstracted data on study aim, assessment format (live theater or simulated setting), skills assessed, and tools or metrics used to assess surgical performance. The strengths, limitations, and psychometric properties of the assessment tools are reported on the basis of previously defined utility criteria. Results: One hundred and five studies published between 1990 and 2019 were included. Forty-two studies involved open orthopaedic surgical procedures, and 63 involved arthroscopy. The majority (85%) were used in the simulated environment. There was wide variation in the type of assessment tools in used, the strengths and weaknesses of which are assessor and setting-dependent. Conclusions: Current technical skills-assessment tools in trauma and orthopaedic surgery are largely procedure-specific and limited to research use in the simulated environment. An objective technical skills-assessment tool that is suitable for use in the live operative theater requires development and validation, to ensure proper competency-based assessment of surgical performance and readiness for unsupervised clinical practice. Clinical Relevance: Trainers and trainees can gain further insight into the technical skills assessment tools that they use in practice through the utility evidence provided.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training

et al. 2020

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“…Each participant was determined to be competent if he or she achieved a final GRS score of competent or above, scored a minimum of 3 in each of the 8 ASSET subdomains as per the study by Koehler et al, 12 or achieved an ASSET score of 24 or greater. 6 No funding was received for this project. All implants and arthroscopic instruments were donated by Arthex.…”

Section: Methodsmentioning

confidence: 99%

Validation of a Dry Model for Assessing the Performance of Arthroscopic Hip Labral Repair

et al. 2017

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“…The arthroscopic Bankart repair and the RCR were performed in the beach-chair or lateral position, again according to fellow preference. Fellows were assessed using a combination of task-specific checklists (previously validated in Sawbones models 14,15 ) and a GRS (the Arthroscopic Surgical Skill Evaluation Tool [ASSET]). 16,17 The ASSET GRS assesses skill in 7 domains on a scale of 1 to 5, with 1 representing novice performance, 3 representing competent performance and 5 representing expert performance: safety, field of view, camera dexterity, instrument dexterity, bimanual dexterity, the flow of the procedure, and the quality of the procedure.…”

Section: Intraoperative Assessmentmentioning

confidence: 99%

“…12,13,22,23 In orthopedics, studies using OSCEs have shown that residents progress over time in training with regard to their clinical knowledge and judgment 12 as well as the performance of technical skills on dry models. 14,15,24 However, previous research assessing the competence of orthopedic residents after a sports medicine rotation found that orthopedic residents were frequently not able to perform advanced arthroscopic procedures competently on dry models, despite focused training. 25 Although research continues to be published assessing competence in orthopedic technical skills using high-fidelity cadaveric models 23,26 and with virtual reality, 27 the assessment of technical skills in the operating room continues to pose challenges.…”

Section: E115mentioning

confidence: 99%

Development of a certification examination for orthopedic sports medicine fellows

Dwyer

Chahal

Murnaghan

et al. 2020

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Background:The purpose of this study was to develop a multifaceted examination to assess the competence of fellows following completion of a sports medicine fellowship.Methods: Orthopedic sports medicine fellows over 2 academic years were invited to participate in the study. Clinical skills were evaluated with objective structured clinical examinations, multiple-choice question examinations, an in-training evaluation report and a surgical logbook. Fellows' performance of 3 technical procedures was assessed both intraoperatively and on cadavers: anterior cruciate ligament reconstruction (ACLR), arthroscopic rotator cuff repair (RCR) and arthroscopic shoulder Bankart repair. Technical procedural skills were assessed using previously validated taskspecific checklists and the Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale.Results: Over 2 years, 12 fellows were assessed. The Cronbach α for the technical assessments was greater than 0.8, and the interrater reliability for the cadaveric assessments was greater than 0.78, indicating satisfactory reliability. When assessed in the operating room, all fellows were determined to have achieved a minimal level of competence in the 3 surgical procedures, with the exception of 1 fellow who was not able achieve competence in ACLR. When their performance on cadaveric specimens was assessed, 2 of 12 (17%) fellows were not able to demonstrate a minimal level of competence in ACLR, 2 of 10 (20%) were not able to demonstrate a minimal level of competence for RCR and 3 of 10 (30%) were not able to demonstrate a minimal level of competence for Bankart repair. Conclusion:There was a disparity between fellows' performance in the operating room and their performance in the high-fidelity cadaveric setting, suggesting that technical performance in the operating room may not be the most appropriate measure for assessment of fellows' competence.Contexte : Le but de cette étude était de concevoir un examen à plusieurs volets pour évaluer la compétence des moniteurs cliniques à la fin de leur formation en médecine sportive.Méthodes : Après leur formation de 2 ans pour devenir orthopédistes en médecine sportive, les moniteurs cliniques ont été invités à participer à l'étude. Leurs habiletés cliniques ont été évaluées au moyen d'examens cliniques objectifs structurés, de questionnaires à choix multiple, d'un rapport d'évaluation en cours de formation et d'un journal de bord chirurgical. Leur habileté à réaliser 3 techniques chirurgicales différentes a été évaluée au bloc opératoire et sur des cadavres : reconstruction du ligament croisé antérieur (RLCA), réparation arthroscopique de la coiffe des rotateurs (RACR) et intervention de Bankart sous endoscopie pour l'épaule. Les habiletés techniques ont été évaluées au moyen de listes de vérification spécifiques aux tâches validées et au moyen de l'outil d'évaluation globale ASSET (Arthroscopic Surgical Skill Evaluation).Résultats : Sur une période de 2 ans, 12 moniteurs ont été évalués. Le coefficient α de Cronbach pour les év...

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Simulation of Anterior Cruciate Ligament Reconstruction in a Dry Model

Abstract: These models may be used to ensure a minimal level of competence before residents and fellows perform ACLR in the operating room.

Cited by 22 publications

References 27 publications

Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training

Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training

Validation of a Dry Model for Assessing the Performance of Arthroscopic Hip Labral Repair

Development of a certification examination for orthopedic sports medicine fellows

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