Transferring simulated arthroscopic skills to the operating theatre

Abstract

The aim of this study was to investigate the effect of laboratory-based simulator training on the ability of surgical trainees to perform diagnostic arthroscopy of the knee. A total of 20 junior orthopaedic trainees were randomised to receive either a fixed protocol of arthroscopic simulator training on a bench-top knee simulator or no additional training. Motion analysis was used to assess performance objectively. Each trainee then received traditional instruction and demonstrations of diagnostic arthroscopy of the knee in theatre before performing the procedure under the supervision of a blinded consultant trainer. Their performance was assessed using a procedure-based assessment from the Orthopaedic Competence Assessment Project and a five-point global rating assessment scale. In theatre the simulator-trained group performed significantly better than the untrained group using the Orthopaedic Competence Assessment Project score (p = 0.0007) and assessment by the global rating scale (p = 0.0011), demonstrating the transfer of psychomotor skills from simulator training to arthroscopy in the operating theatre. This has implications for the planning of future training curricula.

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

“…The incorporation of VR simulators in training regimes offers the potential to reduce error rate which, as well as improving patient outcomes and satisfaction, will also reduce fiscal burden by decreasing the risk of litigation. Seymour et al (2002) showed skills transfer from training on a simulator to the operating theater, and this has been emulated by other studies (Ahlberg et al 2007, Verdaasdonk et al 2008, Larsen et al 2009) including 1 with an orthopedic arthroscopic simulator (Howells et al 2008). Other factors to consider include gender differences, hand dominance, and age correlated with objective scoring.…”

ACGME and ABOS Changes for the Orthopaedic Surgery PGY-1 (Intern) Year

“…This raises the question of whether any skill acquired pertaining to these tasks (which are unlikely to be practiced that year) will be retained after the completion of this module. Skills acquired in simulation laboratories need to be practiced to be retained, and without continued practice the skills may be completely lost in due time [5,6]. Emphasis on techniques interns actually perform may, in time, be used to structure the surgical skills curriculum more effectively.…”

“…While clear goals and objectives for the modules may be developed with relative ease, evidence that surgical simulation skills readily transfer to the operating room is lacking. For example, we do not yet know whether the skills taught during the arthroscopy portion of this curriculum will correlate with performance during an actual procedure [5][6][7].…”

“…Importantly, simulation training is costly, and mandatory implementation of the surgical skills curriculum will require both faculty time and program dollars, resources that are becoming more limited in the current economic climate [4][5][6]9]. The AGCME and ABOS recommend vendor support, especially for equipment and techniques commonly used in a particular residency program.…”

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

“…The ability to perform technical procedures will always be best assessed in the operating room but it can be difficult to standardize surgical procedures [33], manage time restraints [16], and ensure optimal patient safety and clinical outcomes [26]. For these reasons, simulation increasingly is being used to provide opportunities for residents to perform procedures independently, demonstrate knowledge and skills deficits, and commit errors before actually performing surgery on patients in the operating room [2,7,8,13,21,26]. At this time, the best method of assessing a resident's ability to perform an entrustable professional activity independently is unknown.…”