Virtual Reality Compared with Bench-Top Simulation in the Acquisition of Arthroscopic Skill

Banaszek, Daniel; You, Daniel; Chang, Justues; Pickell, Michael; Hesse, Daniel; Hopman, Wilma M.; Borschneck, Daniel; Bardana, Davide D.

doi:10.2106/jbjs.16.00324

Cited by 59 publications

(71 citation statements)

References 27 publications

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“…Previous investigations of simulator training have shown transfer validity of skills between simulator models, 7,17 cadaveric models, 6,8,11,12,14,15,17 and live arthroscopy, 10,13,16 whereas 2 studies found no direct transfer validity between simulator models. 19,20 A recent systematic review and meta-analysis of studies investigating the impact of simulator training on performance showed a strong effect on simulator performance and a moderate effect on human-model (live or cadaveric) performance.…”

Section: Discussionmentioning

confidence: 94%

“…5,6 Previous investigations have generally supported some degree of skill transfer from practice on arthroscopic simulator models to performance on either cadaveric models or live arthroscopy. [7][8][9][10][11][12][13][14][15][16][17][18] However, some investigations have challenged the idea that simulator training provides generalizable skill acquisition. 19,20 In addition, the questions of how much simulator training is necessary and if there is an upper limit to the benefits of simulator training hold particular importance as new simulator technologies are being integrated into residency training programs.…”

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confidence: 99%

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

Wang

Bernardoni

Cotter

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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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

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

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

Wang

Bernardoni

Cotter

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

View full text Add to dashboard Cite

show abstract

“…Yet, skills acquired after virtual reality training did not transfer as readily to the benchtop simulator. 28 Banaszek et al 6 reported similar results but noted significantly greater improvement with high-fidelity virtual simulation compared with low-fidelity benchtop simulation. We echo the authors of each of these studies, who were all careful to note that additional studies on simulator training are still warranted.…”

Section: Discussionmentioning

confidence: 77%

Efficacy of a Virtual Arthroscopic Simulator for Orthopaedic Surgery Residents by Year in Training

Yari

Jandhyala²,

Sharareh

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Virtual reality arthroscopic simulators are an attractive option for resident training and are increasingly used across training programs. However, no study has analyzed the utility of simulators for trainees based on their level of training/postgraduate year (PGY).Purpose/Hypothesis:The primary aim of this study was to determine the utility of the ArthroS arthroscopic simulator for orthopaedic trainees based on their level of training. We hypothesized that residents at all levels would show similar improvements in performance after completion of the training modules.Study Design:Descriptive laboratory study.Methods:Eighteen orthopaedic surgery residents performed diagnostic knee and shoulder tasks on the ArthroS simulator. Participants completed a series of training modules and then repeated the diagnostic tasks. Correlation coefficients (r2) were calculated for improvements in the mean composite score (based on the Imperial Global Arthroscopy Rating Scale [IGARS]) as a function of PGY.Results:The mean improvement in the composite score for participants as a whole was 11.2 ± 10.0 points (P = .0003) for the knee simulator and 14.9 ± 10.9 points (P = .0352) for the shoulder simulator. When broken down by PGY, all groups showed improvement, with greater improvements seen for junior-level residents in the knee simulator and greater improvements seen for senior-level residents in the shoulder simulator. Analysis of variance for the score improvement variable among the different PGY groups yielded an f value of 1.640 (P = .2258) for the knee simulator data and an f value of 0.2292 (P = .917) for the shoulder simulator data. The correlation coefficient (r2) was –0.866 for the knee score improvement and 0.887 for the shoulder score improvement.Conclusion:Residents training on a virtual arthroscopic simulator made significant improvements in both knee and shoulder arthroscopic surgery skills.Clinical Relevance:The current study adds to mounting evidence supporting virtual arthroscopic simulator–based training for orthopaedic residents. Most significantly, this study also provides a baseline for evidence-based targeted use of arthroscopic simulators based on resident training level.

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“…A small number of studies have attempted to assess the concurrent validity of several VR simulators, with positive results (Table IV). [43][44][45][46][47] Cannon et al 43 showed orthopaedic residents who had undergone VR simulator training outperformed their control group counterparts at probing scale scores and self-defined global rating scale scores during diagnostic knee arthroscopy in vivo. However, procedural checklist scores were not shown to be significantly different, which has been attributed to the influence of an extreme outlier.…”

Section: Resultsmentioning

confidence: 99%

Does virtual reality simulation have a role in training trauma and orthopaedic surgeons?

Lawrence

et al. 2018

The Bone & Joint Journal

110

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The demonstration of 'real-world' benefits from the use of VR simulation in knee and shoulder arthroscopy is promising. However, evidence supporting its utility in other forms of orthopaedic surgery is lacking. Further studies of validity and utility should be combined with robust analyses of the cost efficiency of validated simulators to justify the financial investment required for their use in orthopaedic training. Cite this article: Bone Joint J 2018;100-B:559-65.

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Virtual Reality Compared with Bench-Top Simulation in the Acquisition of Arthroscopic Skill

Cited by 59 publications

References 27 publications

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

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

Efficacy of a Virtual Arthroscopic Simulator for Orthopaedic Surgery Residents by Year in Training

Does virtual reality simulation have a role in training trauma and orthopaedic surgeons?

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