The Role of Arthroscopic Simulation in Teaching Surgical Skills

Abstract

Background: Following the introduction of worktime regulations across the world along with existing concerns over the nonuniform nature of the traditional apprenticeship model, an alternative method for teaching surgical skills is being sought. Simulation training offers a safe and standardized environment to develop and improve surgical skills. The purpose of the present study was to review the existing and most recent research into the utility of arthroscopic simulators in training and the teaching of surgical skills. Methods: A systematic review of the MEDLINE, Embase, and Cochrane Library databases for English-language articles published between 2014 and November 2017 was conducted. Search terms included arthroscopy or arthroscopic with simulation or simulator. Results: We identified a total of 27 relevant studies involving simulated ankle, knee, shoulder, hip, and simple box arthroscopic environments. The majority of these studies demonstrated construct validity, while a few demonstrated transfer, face, and content validity. Conclusions: Our review suggests that there is a considerable evidence base regarding the use of arthroscopic simulators for training purposes. Further work should focus on the development of a standardized simulator training course that can be contrasted against current intraoperative training in large-scale multicenter trials with long-term follow-up.

Aktueller Stand virtueller Simulatoren für die chirurgische Ausbildung in Orthopädie und Unfallchirurgie

“…Inhaltsvalidität ("content validity") bezeichnet die Messung verschiedener arthroskopischer Fähigkeiten [26,27,29]. Am besten eignen sich dazu objektive Messparameter (z.…”

“…So konnten verschiedene Studien zeigen, dass sich die für die jeweilig abgefragte arthroskopische Aufgabe benötigte Zeit insbesondere bei Anfängern mit der Anzahl der Wiederholungen verkürzt [27]. Bei Fortgeschrittenen war dieser Effekt nicht in allen Studien signifikant [26,29].…”

Editorial Commentary: Harnessing Surgical Simulation—Saddle up for a Long and Rigorous Ride!

“…Simulators of varying fidelities will be needed to optimize training curricula. 23 Medium-and highfidelity (VR) simulations will be particularly valuable for training more complex tasks, as well as exhibiting varied and even patient-specific pathologies. As the sophistication of VR simulators continue to evolve, they will be required not only to determine whether tasks were completed but also to assess whether errors were enacted.…”

The Effect of Triangulation Simulator Training on Arthroscopy Skills: A Prospective Randomized Controlled Trial

“…In particular, there is heightened interest in implementing arthroscopic simulation into orthopaedic residency training. 3,4 Currently, a plethora of arthroscopic trainers, which range from low-fidelity, nonanatomic simulation models, such as triangulation box systems, to high-fidelity simulation models, such as anatomic virtual-reality systems, are available. Simulation offers trainees a protected, controlled environment in which they can practice and acquire skills safely outside of the operating room.…”

“…Despite the proposed advantages of simulation training, there remains no consensus gold-standard simulation model or protocol. 4 Authors have shown that some anatomic knee and shoulder simulators can be valuable arthroscopy training tools and may aid in the development of skills transferable to cadaveric or patient models. 10e13 However, several anatomic virtual-reality or laboratory-based trainers may be impractical or cost prohibitive, leading to barriers to implementation.…”