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Schreiner B, Unger R, Herzka AS, Friess DM, Nazir OF, Brady JM. A Curricular Model for Simulation Within Orthopaedic Residency Training. JB JS Open Access 2024; 9:e23.00114. [PMID: 38572497 PMCID: PMC10984657 DOI: 10.2106/jbjs.oa.23.00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Introduction American Board of Orthopaedic Surgery/American Council on GraduateMedical Education Residency Review Committee training requirements have necessitated the need for the adoption of simulation education into existing programmatic requirements. Current guidelines focus only on interns at a potentially significant cost to programs; both in total dollar amount and time. Methods The authors aim to provide a model that can maximize utility for all resident levels, manage cost by maximizing the use of cadaveric material, and allow integration of varied industry support. Results The Oregon Health & Science University Orthopaedic education program has developed a high-fidelity training curriculum that (1) is applicable to both junior and senior residents (2) has minimized the cost per resident with the reuse of cadaveric specimens and (3) has nurtured partnerships with industry stakeholders to reduce bias in training by collaborating with most major industry representatives. Conclusion The simulation curriculum outlined in this manuscript may serve as a reference for other programs and institutions to develop their own residency educational curriculum models.
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Affiliation(s)
- Bryan Schreiner
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Robert Unger
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Andrea S. Herzka
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Darin M. Friess
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Omar F. Nazir
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Jacqueline M. Brady
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Scott-Watson M, Thornhill C, Bhattacharyya R, Spencer SJ. Evaluating the effectiveness of a low fidelity, easily available simulator to teach basic arthroscopy skills to novice learners: A prospective cohort study. Knee 2024; 47:129-138. [PMID: 38394992 DOI: 10.1016/j.knee.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Arthroscopy proficiency is key to being a competent orthopaedic surgeon and acquiring arthroscopic skills takes years of exposure and diligent practice. However, today's graduating consultants have had considerably less time in operating theatre than their senior colleagues at the same point of their careers. OBJECTIVES To evaluate whether: (1) Students could improve their arthroscopic technique using a low fidelity arthroscopic training tool (2) students enjoyed the use of the simulator (3) If certain demographics correlate to performance on the simulator. METHODS Medical students who have no previous training in arthroscopy were included. A combined left- and right-handed timed run with a low-fidelity arthroscopic triangulation simulator was recorded before and after 40-minutes of practice. RESULTS 84 participants took part with an average improvement of was 66.8%. Students felt that their arthroscopic skills increased on average by 36.4%. 73 of the 84 participants gave the maximum score of 5 when asked if they enjoyed the session and 74 participants gave the maximum score of 5 as to whether they would be interested in participating in further sessions. Factors such as biological sex, video game play and sports were found to be statistically significant to performance. CONCLUSIONS This study showed a statistically significant improvement in students' arthroscopic performance with a low-fidelity arthroscopic simulator. Students found the experience useful with the vast majority indicating interest in completing further training sessions to help improve practical surgical skills. Video gamers, sports players and males were found to have a correlation with performance on the simulator.
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Affiliation(s)
- Malcolm Scott-Watson
- Glasgow University Medical Student, Wolfson Medical School Building, University Avenue, University of Glasgow, G12 8QQ, UK.
| | - Chris Thornhill
- ST3 Orthopaedic and Trauma Surgeon, Queen Elizabeth University Hospital, 1345 Govan Road, Govan G51 4TF, Glasgow, UK.
| | - Rahul Bhattacharyya
- Consultant Orthopaedic and Trauma Surgeon, NHS Lanarkshire University Hospitals, UK.
| | - Simon J Spencer
- Consultant Orthopaedic and Trauma Surgeon, Queen Elizabeth University Hospital, 1345 Govan Road, Govan G51 4TF, Glasgow, UK.
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Kenanidis E, Boutos P, Voulgaris G, Zgouridou A, Gkoura E, Gamie Z, Papagiannakis G, Tsiridis E. Effectiveness of virtual reality compared to video training on acetabular cup and femoral stem implantation accuracy in total hip arthroplasty among medical students: a randomised controlled trial. INTERNATIONAL ORTHOPAEDICS 2024; 48:625-633. [PMID: 37993676 PMCID: PMC10901922 DOI: 10.1007/s00264-023-06038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Virtual reality (VR) training effectiveness in improving hip arthroplasty surgical skills requires further evaluation. We hypothesised VR training could improve accuracy and the time taken by medical students compared to a control group with only video teaching. METHODS This single-centre randomized controlled clinical trial collected data from March to June 2023. Surgically naïve volunteer undergraduate medical students performed three sessions on a VR training platform, either cup (VR-Cup=Control-Stem) or stem (VR-Stem=Control-Cup) implantation. The primary outcome was the mean difference between predefined cup inclination (60°) and stem anteversion (20°) compared to the actual implanted values in sawbones between VR and control groups. Secondary outcomes were task completion time and mistake number between the groups. RESULTS A total of 101 students participated (VR-Cup 47, VR-Stem 54). Groups did not significantly differ concerning age (p = 0.879), gender (p = 0.408), study year (p = 0.938), previous VR use (p = 0.269) and baseline medical and procedural knowledge. The VR-Cup implanted the cup closer to the intended target (p < 0.001) and faster than the Control-Cup group (p = 0.113). The VR-Stem implanted the stem closer to the intended target (p = 0.008) but not faster than the Control-Cup group (p = 0.661). Stem retroversion was commoner in the Control-Stem than in the VR-Stem group (p = 0.016). CONCLUSIONS VR training resulted in higher rates of accurate procedure completion, reduced time and fewer errors compared to video teaching. VR training is an effective method for improving skill acquisition in THA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05807828.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece.
| | - Panagiotis Boutos
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Grigorios Voulgaris
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Aikaterini Zgouridou
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Eleni Gkoura
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Zakareya Gamie
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - George Papagiannakis
- Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Greece
- Department of Computer Science, University of Crete, Heraklion, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
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Knowlin LT, Laskay NMB, Jules NP, Godzik J, Chang TP, Spurrier RG. Advances in Pediatric Surgery Simulation-Based Training. CHILDREN (BASEL, SWITZERLAND) 2023; 11:34. [PMID: 38255348 PMCID: PMC10813955 DOI: 10.3390/children11010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Pediatric surgery is the diagnostic, operative, and postoperative surgical care of children with congenital and acquired anomalies and diseases. The early history of the specialty followed the classic "see one, do one, teach one" philosophy of training but has since evolved to modern methods including simulation-based training (SBT). Current trainees in pediatric surgery face numerous challenges, such as the decreasing incidence of congenital disease and reduced work hours. SBT consists of several modalities that together assist in the acquisition of technical skills and improve performance in the operating room. SBT has evolved to incorporate simulator models and video gaming technology, in parallel with the development of simulation in other surgical and non-surgical pediatric fields. SBT has advanced to a level of sophistication that means that it can improve the skills of not only pediatric surgery trainees but also practicing attending surgeons. In this review, we will discuss the history of pediatric surgery, simulation in pediatric surgery training, and the potential direction of pediatric surgical simulation training in the future.
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Affiliation(s)
- Laquanda T. Knowlin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #175, Los Angeles, CA 90027, USA
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Nicholas M. B. Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Nehemie P. Jules
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Jakub Godzik
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Todd P. Chang
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Ryan G. Spurrier
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #175, Los Angeles, CA 90027, USA
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Zhang H, Wang J, Liu C, Du B, Xiao J, Qian L, Zhang Q, Li J. Development of a continuously perfused ex vivo kidney training model for laparoscopic partial nephrectomy: validity and efficiency. Int J Surg 2023; 109:3919-3928. [PMID: 37737884 PMCID: PMC10720863 DOI: 10.1097/js9.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Suture hemostasis is essential for laparoscopic partial nephrectomy (LPN). This study aimed to develop, validate, and test the efficacy of a continuously perfused training model (CPTM) in LPN with high-level simulated bleeding. MATERIALS AND METHODS The CPTM was constructed using fresh porcine kidneys with renal arteries continuously perfused with red-dyed liquid gelatin. Twenty-nine participants with expert, intermediate, or novice laparoscopic experience levels were recruited. The expert and intermediate participants evaluated the CPTM, and the novice participants were randomly assigned to one of two groups to complete training on a CPTM or dry box training model (DBTM). Messick's framework criteria were utilized to assess the validity and training efficacy of the model. The data were analyzed using the Mann-Whitney U , Kruskal-Wallis, and Friedman tests. A value of P< 0.05 was considered statistically significant. RESULTS Positive comments were provided by all experts and intermediates for the Content . The Relationships with other variables demonstrated significant differences among novices, intermediates, and experts in all metrics ( P< 0.05). The Consequences showed that the CPTM helped novices acquire LPN skills. The training efficacy was significantly better than that of the DBTM ( P< 0.05). There were no significant differences between the final performances of the novices and the initial performances of the experts ( P >0.05). Synthesizing all metrics, the LPN skills learned using CPTMs were significantly improved in the 12th round of training. CONCLUSION The CPTM offered a high-level simulation of bleeding with realistic tissue texture for acquiring LPN skills. Training of no fewer than 12 rounds is recommended for a novice's LPN training on the CPTM.
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Affiliation(s)
| | - Jun Wang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences
| | - Chundong Liu
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou
| | - Bingran Du
- Department of Stomatology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan
| | - Jujiao Xiao
- Center of Clinical Skills, Affiliated Jining First People's Hospital, Shandong First Medical University, Jining
| | - Lei Qian
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences
| | - Qun Zhang
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences
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Howard T, Iyengar KP, Vaishya R, Ahluwalia R. High-fidelity virtual reality simulation training in enhancing competency assessment in orthopaedic training. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 37769263 DOI: 10.12968/hmed.2022.0360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Surgical competence is the ability to successfully apply academic knowledge, clinical skills and professional behaviour to inpatient care. Along with ensuring patient safety, the ability to communicate effectively, collaborative teamwork and probity, and achieving satisfactory competencies form the fundamental principles of good medical practice. Current strategies to develop surgical competencies include a range of formative and summative assessments. The cancellation of traditional face-to-face meetings and training opportunities during the COVID-19 pandemic had a profound impact on the delivery of medical education and opportunities to achieve surgical competencies. Simulation learning has been used since before the pandemic to deliver surgical training across all grades and specialities, including orthopaedic surgery. Simulation-based training provides a safe, controlled environment to develop skill acquisition. Simulated surgery using virtual reality has evolved following developments in software and hardware. This article explores the role of high-fidelity virtual reality simulation to assess competencies in orthopaedic training in the post-COVID-19 era, and examines whether simulation could be used within the curriculum to augment and improve training.
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Affiliation(s)
- Theodore Howard
- Department of Trauma and Orthopaedics, King's College Hospital, London, UK
- Department of Trauma and Orthopaedics, Imperial College London, London, UK
| | - Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - Raju Ahluwalia
- Department of Trauma and Orthopaedics, King's College Hospital, London, UK
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Mondal S, Kelkar AS, Singh R, Jayadev C, Saravanan VR, Kelkar JA. What do retina fellows-in-training think about the vitreoretinal surgical simulator: A multicenter survey. Indian J Ophthalmol 2023; 71:3064-3068. [PMID: 37530282 PMCID: PMC10538810 DOI: 10.4103/ijo.ijo_381_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To profile vitreoretinal (VR) fellows-in-training from India exposed to the Eyesi surgical simulator, to identify potential barriers to voluntary use, and enumerate the most preferred tools and tasks before incorporating them into a formal skill-transfer curriculum. Methods A questionnaire consisting of 22 questions was designed and circulated through an online portal (surveymonkey.com) to four different institutes of India having a VR surgical fellowship program and using a functional Eyesi (Haag-Streit) simulator. All fellows and trainees who were exposed to the simulator were eligible to participate, irrespective of time spent on the simulator and exposure to training steps on real patients. The responses collected were private and anonymous. Results Of the 37 respondents, most (n = 25, 68%) considered surgical simulators to be the best training tool before operating on the human eye. A majority (n = 35, 94.5%) of participants spent <3 h per week on the simulator, which, most (n = 30, 81%) felt was not enough time. The main reasons for this underutilization were work-hour limitations (54.8%), lack of a structured training program (19.3%), or a dedicated supervisor (16.1%). Again, the majority (n = 33, 89%) of participants responded that VR surgical skills acquired during simulator training were transferrable to the operating room, which was reflected by their response (n = 31, 83.7%) that simulator-based training should be made mandatory before operating room exposure. Conclusion This study gives an insight into the overall practice patterns and preferences in simulation training of surgical VR fellows-in-training across India. It indicates that the simulator is extremely helpful to fellows and if adopted, VR surgical simulators with organized, directed, and supervised sessions will considerably improve the surgical training experience.
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Affiliation(s)
- Sukanya Mondal
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Ramandeep Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chaitra Jayadev
- Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | | | - Jai A Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
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Patel S, Ouellet J, Driscoll M. Examining impact forces during posterior spinal fusion to implement in a novel physics-driven virtual reality surgical simulator. Med Biol Eng Comput 2023:10.1007/s11517-023-02819-w. [PMID: 36952119 DOI: 10.1007/s11517-023-02819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Abstract
This study aims to understand the impact forces that surgeons apply to the human spine during a posterior spinal fusion procedure towards the development of a novel spine surgical simulator for training medical residents. The foci of this study are impact forces during graft placement and spinal interbody cage insertion. This study examined the lumbar intervertebral discs of two male cadaveric specimens. Impact forces were collected during graft and spinal cage insertion over multiple levels. An impulse hammer and a camera were used to collect impact forces and displacements, respectively. The results demonstrated a logarithmic relationship between impact forces and cumulative displacement during graft placement. This was also observed between cumulative displacement and number of impacts during spinal cage insertion. A linear relationship was observed for the impact forces and number of impacts during graft placement. Results suggest that surgeons rely on the feedback experienced from impact forces during graft insertion to gauge the amount of graft that was placed in a specific area of the disc. Impact forces during cage insertion provide information about any encountered obstacles. When developing surgical simulators, designing the force feedback system should require modelling these behaviors to effectively impart corresponding skills on a trainee.
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Affiliation(s)
- Sneha Patel
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
| | - Jean Ouellet
- Orthopaedic Research Lab, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada.
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Application of Virtual Reality Systems in Bone Trauma Procedures. Medicina (B Aires) 2023; 59:medicina59030562. [PMID: 36984563 PMCID: PMC10058640 DOI: 10.3390/medicina59030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Objectives: Bone fractures contribute significantly to the global disease and disability burden and are associated with a high and escalating incidence and tremendous economic consequences. The increasingly challenging climate of orthopaedic training and practice re-echoes the established potential of leveraging computer-based reality technologies to support patient-specific simulations for procedural teaching and surgical precision. Unfortunately, despite the recognised potential of virtual reality technologies in orthopaedic surgery, its adoption and integration, particularly in fracture procedures, have lagged behind other surgical specialities. We aimed to review the available virtual reality systems adapted for orthopaedic trauma procedures. Materials and Methods: We performed an extensive literature search in Medline (PubMed), Science Direct, SpringerLink, and Google Scholar and presented a narrative synthesis of the state of the art on virtual reality systems for bone trauma procedures. Results: We categorised existing simulation modalities into those for fracture fixation techniques, drilling procedures, and prosthetic design and implantation and described the important technical features, as well as their clinical validity and applications. Conclusions: Over the past decade, an increasing number of high- and low-fidelity virtual reality systems for bone trauma procedures have been introduced, demonstrating important benefits with regard to improving procedural teaching and learning, preoperative planning and rehearsal, intraoperative precision and efficiency, and postoperative outcomes. However, further technical developments in line with industry benchmarks and metrics are needed in addition to more standardised and rigorous clinical validation.
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Sun P, Zhao Y, Men J, Ma ZR, Jiang HZ, Liu CY, Feng W. Application of Virtual and Augmented Reality Technology in Hip Surgery: Systematic Review. J Med Internet Res 2023; 25:e37599. [PMID: 36651587 PMCID: PMC10039409 DOI: 10.2196/37599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/07/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Virtual and augmented reality (VAR) represents a combination of current state-of-the-art computer and imaging technologies and has the potential to be a revolutionary technology in many surgical fields. An increasing number of investigators have developed and applied VAR in hip-related surgery with the aim of using this technology to reduce hip surgery-related complications, improve surgical success rates, and reduce surgical risks. These technologies are beginning to be widely used in hip-related preoperative operation simulation and training, intraoperative navigation tools in the operating room, and postoperative rehabilitation. OBJECTIVE With the aim of reviewing the current status of virtual reality (VR) and augmented reality (AR) in hip-related surgery and summarizing its benefits, we discussed and briefly described the applicability, advantages, limitations, and future perspectives of VR and AR techniques in hip-related surgery, such as preoperative operation simulation and training; explored the possible future applications of AR in the operating room; and discussed the bright prospects of VR and AR technologies in postoperative rehabilitation after hip surgery. METHODS We searched the PubMed and Web of Science databases using the following key search terms: ("virtual reality" OR "augmented reality") AND ("pelvis" OR "hip"). The literature on basic and clinical research related to the aforementioned key search terms, that is, studies evaluating the key factors, challenges, or problems of using of VAR technology in hip-related surgery, was collected. RESULTS A total of 40 studies and reports were included and classified into the following categories: total hip arthroplasty, hip resurfacing, femoral neck fracture, pelvic fracture, acetabular fracture, tumor, arthroscopy, and postoperative rehabilitation. Quality assessment could be performed in 30 studies. Among the clinical studies, there were 16 case series with an average score of 89 out of 100 points (89%) and 1 case report that scored 81 (SD 10.11) out of 100 points (81%) according to the Joanna Briggs Institute Critical Appraisal Checklist. Two cadaveric studies scored 85 of 100 points (85%) and 92 of 100 points (92%) according to the Quality Appraisal for Cadaveric Studies scale. CONCLUSIONS VR and AR technologies hold great promise for hip-related surgeries, especially for preoperative operation simulation and training, feasibility applications in the operating room, and postoperative rehabilitation, and have the potential to assist orthopedic surgeons in operating more accurately and safely. More comparative studies are necessary, including studies focusing on clinical outcomes and cost-effectiveness.
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Affiliation(s)
- Peng Sun
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Yao Zhao
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Jie Men
- Department of Bone and Joint Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yan tai, China
| | - Zhe-Ru Ma
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Hao-Zhuo Jiang
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Cheng-Yan Liu
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Wei Feng
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
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Cai B, Xu N, Duan S, Yi J, Bay BH, Shen F, Hu N, Zhang P, Chen J, Chen C. Eye tracking metrics of orthopedic surgeons with different competency levels who practice simulation-based hip arthroscopic procedures. Heliyon 2022; 8:e12335. [PMID: 36582732 PMCID: PMC9792746 DOI: 10.1016/j.heliyon.2022.e12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/16/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Objective This study aimed to investigate the feasibility of using eye tracking data to identify orthopedic trainees' technical proficiency in hip arthroscopic procedures during simulation-based training. Design A cross sectional study. Setting A simulation-based training session for hip arthroscopy was conducted. Eye tracking devices were used to record participants' eye movements while performing simulated operations. The NASA Task Load Index survey was then used to measure subjective opinions on the perceived workload of the training. Statistical analyses were performed to determine the significance of the eye metrics and survey data. Participants A total of 12 arthroscopic trainees, including resident doctors, junior specialist surgeons, and consultant surgeons from the Department of Orthopedics in five hospitals, participated in this study. They were divided into three subgroups based on their prior clinical experience. Results Significant differences, including those for dwell time, number of fixations, number of saccades, saccade duration, peak velocity of the saccade, and pupil entropy, were observed among the three subgroups. Additionally, there were clear trends in the perceived workload of the simulation-based training based on feedback from the participants. Conclusion Based on this preliminary study, a correlation was identified between the eye tracking metrics and participants' experience levels. Hence, it is feasible to apply eye tracking data as a supplementary objective assessment tool to benchmark the technical proficiency of surgical trainees in hip arthroscopy, and enhance simulation-based training.
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Affiliation(s)
- Bohong Cai
- Department of Industrial and Product Design, School of Design, Sichuan Fine Arts Institute, Chongqing, China
| | - Na Xu
- Department of Industrial and Product Design, School of Design, Sichuan Fine Arts Institute, Chongqing, China
| | - Shengfeng Duan
- Department of Industrial and Product Design, School of Design, Sichuan Fine Arts Institute, Chongqing, China
| | - Jiahui Yi
- Department of Industrial and Product Design, School of Design, Sichuan Fine Arts Institute, Chongqing, China
| | - Boon Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fangyuan Shen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ning Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Zhang
- Department of Orthopedics, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Jie Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Corresponding author.
| | - Cheng Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Corresponding author.
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12
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Filliquist B, Kapatkin AS, Vernau KM, Nakatani JY, Chou PY, Ilkiw JE. Training Surgical Residents Utilizing an Animal Shelter Fracture Program. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:778-784. [PMID: 34779752 DOI: 10.3138/jvme-2021-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Working relationships between veterinary medical teaching hospitals, animal shelters, and rescue groups are one way to increase veterinary students' and residents' hands-on training. The goal of this study is to describe the use of a shelter fracture program to improve the surgical skills of surgical residents. In this program, the participating shelter and rescue organizations electronically submit cases. Following evaluation of radiographs and case approval by the orthopedic faculty, the case is scheduled for a physical evaluation. A resident takes primary surgical care together with a fourth-year student rotating through the orthopedic surgery service to ensure the proper pre-, peri-, and post-operative standard of care. All care is overseen by the orthopedic faculty. A veterinary student-run fracture foster program allows students to gain additional experience in the pre-, peri-, and post-operative care of shelter animals. The total number of shelter animals treated during a 9-year period was 373, with a mean annual case load of 41.1 cases (± 10.3). During the same time period, a total of 435 client-owned cases underwent surgical fracture treatment, with a mean annual case load of 48 cases (± 11.7). Surgical resident and student surveys show that this program contributes to their knowledge, skills, and confidence in treating fracture patients. A successful cooperative program provides advanced surgical fracture treatment of shelter animals, improving animals' quality of life as well as surgical residents' and veterinary students' skills training.
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13
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Schmoelz W, Zierleyn JP, Hoermann R, Arora R. Standardized fracture creation in the distal humerus and the olecranon for surgical training and biomechanical testing. Arch Orthop Trauma Surg 2022; 142:3853-3861. [PMID: 34973090 PMCID: PMC9596540 DOI: 10.1007/s00402-021-04286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/27/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Surgical training and biomechanical testing require models that realistically represent the in vivo injury condition. The aim of this work was to develop and test a method for the generation of distal humerus fractures and olecranon fractures in human specimens, while preserving the soft tissue envelope. METHODS Twenty-one cadaveric upper extremity specimens (7 female, 14 male) were used. Two different experimental setups were developed, one to generate distal humerus fractures and one to generate olecranon fractures. Specimens were placed in a material testing machine and fractured with a predefined displacement. The force required for fracturing and the corresponding displacement were recorded and the induced energy was derived of the force-displacement graphs. After fracturing, CT imaging was performed and fractures were classified according to the AO classification. RESULTS Eleven distal humerus fractures and 10 olecranon fractures with intact soft tissue envelope could be created. Distal humerus fractures were classified as AO type C (n = 9) and as type B (n = 2), all olecranon fractures were classified as AO type B (n = 10). Distal humerus fractures required significantly more load than olecranon fractures (6077 N ± 1583 vs 4136 N ± 2368, p = 0.038) and absorbed more energy until fracture than olecranon fractures (17.8 J ± 9.1 vs 11.7 J ± 7.6, p = 0.11), while the displacement at fracture was similar (5.8 mm ± 1.6 vs 5.9 mm ± 3.1, p = 0.89). CONCLUSION The experimental setups are suitable for generating olecranon fractures and distal humerus fractures with intact soft tissue mantle for surgical training and biomechanical testing.
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Affiliation(s)
- Werner Schmoelz
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Jan Philipp Zierleyn
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Romed Hoermann
- Division Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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14
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Lisiecki JL, Johnson SP, Grant D, Chung KC. Learners' Responses to a Virtual Cadaver Dissection Nerve Course in the COVID Era: A Survey Study. Arch Plast Surg 2022; 49:676-682. [PMID: 36159381 PMCID: PMC9507583 DOI: 10.1055/s-0042-1756351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background
Virtual education is an evolving method for teaching medical learners. During the coronavirus disease 2019 pandemic, remote learning has provided a replacement for conferences, lectures, and meetings, but has not been described as a method for conducting a cadaver dissection. We aim to demonstrate how learners perceive a virtual cadaver dissection as an alternative to live dissection.
Methods
A virtual cadaver dissection was performed to demonstrate several upper extremity nerve procedures. These procedures were livestreamed as part of an educational event with multimedia and interactive audience questions. Participants were queried both during and after the session regarding their perceptions of this teaching modality.
Results
Attendance of a virtual dissection held for three plastic surgery training institutions began at 100 and finished with 70 participants. Intrasession response rates from the audience varied between 68 and 75%, of which 75% strongly agreed that they were satisfied with the virtual environment. The audience strongly agreed or agreed that the addition of multimedia captions (88%), magnified video loupe views (82%), and split-screen multicast view (64%) was beneficial. Postsession response rate was 27%, and generally reflected a positive perspective about the content of the session.
Conclusions
Virtual cadaver dissection is an effective modality for teaching surgical procedures and can be enhanced through technologies such as video loupes and multiple camera perspectives. The audience viewed the virtual cadaver dissection as a beneficial adjunct to surgical education. This format may also make in-person cadaver courses more effective by improving visualization and allowing for anatomic references to be displayed synchronously.
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Affiliation(s)
- Jeffrey L Lisiecki
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Shepard Peir Johnson
- Section of Plastic Surgery & Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - David Grant
- Section of Plastic Surgery & Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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15
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Haiser A, Aydin A, Kunduzi B, Ahmed K, Dasgupta P. A Systematic Review of Simulation-Based Training in Vascular Surgery. J Surg Res 2022; 279:409-419. [PMID: 35839575 PMCID: PMC9483723 DOI: 10.1016/j.jss.2022.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 11/25/2022]
Abstract
Introduction Recent advancements in surgical technology, reduced working hours, and training opportunities exacerbated by the COVID-19 pandemic have led to an increase in simulation-based training. Furthermore, a rise in endovascular procedures has led to a requirement for high-fidelity simulators that offer comprehensive feedback. This review aims to identify vascular surgery simulation models and assess their validity and levels of effectiveness (LoE) for each model in order to successfully implement them into current training curricula. Methods PubMed and EMBASE were searched on January 1, 2021, for full-text English studies on vascular surgery simulators. Eligible articles were given validity ratings based on Messick’s modern concept of validity alongside an LoE score according to McGaghie’s translational outcomes. Results Overall 76 eligible articles validated 34 vascular surgery simulators and training courses for open and endovascular procedures. High validity ratings were achieved across studies for: content (35), response processes (12), the internal structure (5), relations to other variables (57), and consequences (2). Only seven studies achieved an LoE greater than 3/5. Overall, ANGIO Mentor was the most highly validated and effective simulator and was the only simulator to achieve an LoE of 5/5. Conclusions Simulation-based training in vascular surgery is a continuously developing field with exciting future prospects, demonstrated by the vast number of models and training courses. To effectively integrate simulation models into current vascular surgery curricula and assessments, there is a need for studies to look at trainee skill retention over a longer period of time. A more detailed discussion on cost-effectiveness is also needed.
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Affiliation(s)
- Alexander Haiser
- Guy's, King's and St Thomas' School of Medical Education, King's College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.
| | - Basir Kunduzi
- Department of Transplant Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
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16
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Trauma Bay Virtual Reality - A Game Changer for ATLS Instruction and Assessment. J Trauma Acute Care Surg 2022; 93:353-359. [PMID: 35170584 DOI: 10.1097/ta.0000000000003569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medical educational research highlights the need for high-fidelity, multidisciplinary simulation training to teach complex decision-making skills such as those taught in ATLS. This approach is, however, expensive and time intensive. Virtual reality (VR) education simulation may improve skill acquisition in a cost-effective and time-sensitive manner. We developed a novel trauma VR simulator (TVRSim) for providers to apply ATLS principles. We hypothesized in this pilot study that TVRSim could differentiate practitioner competency with increasing experience and would be well accepted. METHODS Providers at a level 1 trauma center (acute care surgeons, novice (MS4 & PGY1), junior (PGY2 & 3), senior (PGY4-6) residents) ran a blunt, polytrauma VR code. Ten critical decision points were assessed: intubation, cricothyroidotomy, chest tube, IV access, FAST, pelvic binder, activation of MTP, administration of hypertonic saline (HTS), hyperventilation and decision to go to the OR. Learner assessment was based upon frequency and time to correct decisions. Participant satisfaction was measured using validated surveys. RESULTS All 31 providers intubated and obtained IV access. Novices and juniors frequently failed at HTS and hyperventilation decisions. Juniors often failed at cricothyroidotomy (60%), and OR (100%) decisions. Mean time to all decisions except going to the OR was longer for all groups compared to ACS surgeons. Mean number of decisions/min was significantly higher for surgeons and seniors compared to juniors and novices. Mortality was 92.3% for novices, 80% for juniors, 25% for seniors and 0% for the attendings. Participants found TVRSim comfortable, easy to use/interact with/performance enhancing, and helped develop skills and learning. CONCLUSIONS In this pilot study using a sample of convenience, TVRSim was able to discern decision-making abilities among trainees with increasing experience. All trainees felt the platform enhanced their performance and facilitated skill acquisition and learning. TVRSim could be a useful adjunct to teach and assess ATLS skills. LEVEL OF EVIDENCE III, diagnostic test/education.
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17
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Ponseti Clubfoot Casting: Factors That Affect Trainee Competency (Retrospective Observational Study). J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202202000-00009. [PMID: 35167507 PMCID: PMC8849277 DOI: 10.5435/jaaosglobal-d-22-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/18/2022]
Abstract
Introduction: This study investigates how previous simulation training and clinical experience affects trainee performance when manipulating a foot, applying a Ponseti clubfoot cast, and performing an Achilles tenotomy on a clubfoot simulator. Methods: Sixty-four Accreditation Council for Graduate Medical Education orthopaedic trainees participated in the 2017 to 2018 Top Gun (TG) skills competition at the International Pediatric Orthopaedic Symposium. Trainees were judged by expert pediatric orthopaedic surgeons on how they manipulated a clubfoot model, applied a cast, and performed a simulated tendoachilles tenotomy (TAT). An analysis was done to correlate the test variables with a contestant's TG Ponseti score. Results: Twenty-one contestants with previous residency training using synthetic clubfoot models scored higher (P = 0.007) than those trainees without training. Trainees who had applied >10 clubfoot casts and who participated in >10 TATs in training also scored higher (P = 0.038 and P = 0.01, respectively). Thirteen contestants who had previously attended an International Pediatric Orthopaedic Symposium meeting and seven contestants who attended a American Academy of Orthopaedic Surgery clubfoot workshop scored higher (P = 0.012 and P = 0.017 respectively). Discussion: Clinical and previous simulation experience related to the Ponseti method correlated with improved performance on our Ponseti simulation. Trainees who had previous experience with >10 clubfoot casts and >10 TATs scored higher during TG than less experienced trainees.
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18
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Goh GS, Lohre R, Parvizi J, Goel DP. Virtual and augmented reality for surgical training and simulation in knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:2303-2312. [PMID: 34264380 DOI: 10.1007/s00402-021-04037-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Immersive virtual reality (IVR), augmented reality and mixed reality form a spectrum of extended reality technology integration that has gained popularity in orthopaedics recently. This review article examines the role of extended reality technologies in knee arthroplasty. METHODS Existing literature on the applications of extended reality technologies in preoperative planning and intraoperative navigation were reviewed. A sample workflow of a novel IVR simulator for improving surgical training was also provided to demonstrate its utility in educating trainees on knee arthroplasty techniques. RESULTS Extended reality technologies enable the surgeon to visualise patient-specific anatomy in real-time, enhancing preoperative planning and providing intraoperative guidance. IVR technology has the potential to revolutionise modern surgical training and optimise surgical performance in a cost-efficient manner, with current evidence demonstrating favourable immediate skill acquisition and transfer. CONCLUSIONS Extended reality technologies have a myriad of potential applications in orthopaedic surgery. Further research is needed to evaluate the cost-effectiveness of its incorporation into training programmes.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Lohre
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Danny P Goel
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada. .,Department of Orthopaedic Surgery, University of British Columbia, 321 Water Street, Suite 500, Vancouver, BC, V6B 1B8, Canada.
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19
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Unsupervised feature disentanglement for video retrieval in minimally invasive surgery. Med Image Anal 2021; 75:102296. [PMID: 34781159 DOI: 10.1016/j.media.2021.102296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022]
Abstract
In this paper, we propose a novel method of Unsupervised Disentanglement of Scene and Motion (UDSM) representations for minimally invasive surgery video retrieval within large databases, which has the potential to advance intelligent and efficient surgical teaching systems. To extract more discriminative video representations, two designed encoders with a triplet ranking loss and an adversarial learning mechanism are established to respectively capture the spatial and temporal information for achieving disentangled features from each frame with promising interpretability. In addition, the long-range temporal dependencies are improved in an integrated video level using a temporal aggregation module and then a set of compact binary codes that carries representative features is yielded to realize fast retrieval. The entire framework is trained in an unsupervised scheme, i.e., purely learning from raw surgical videos without using any annotation. We construct two large-scale minimally invasive surgery video datasets based on the public dataset Cholec80 and our in-house dataset of laparoscopic hysterectomy, to establish the learning process and validate the effectiveness of our proposed method qualitatively and quantitatively on the surgical video retrieval task. Extensive experiments show that our approach significantly outperforms the state-of-the-art video retrieval methods on both datasets, revealing a promising future for injecting intelligence in the next generation of surgical teaching systems.
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20
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Putzer D, Dammerer D, Baldauf M, Lenze F, Liebensteiner MC, Nogler M. A Prospective Assessment of Knee Arthroscopy Skills Between Medical Students and Residents-Simulator Exercises for Partial Meniscectomy and Analysis of Learning Curves. Surg Innov 2021; 29:398-405. [PMID: 34565232 PMCID: PMC9227956 DOI: 10.1177/15533506211037792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The Covid-19 pandemic has created the largest disruption of education in history. In a response to this, we aimed to evaluate the knee arthroscopy learning curve among medical students and orthopaedic residents. Methods An arthroscopy simulator was used to compare the learning curves of two groups. Medical students with any prior knowledge of arthroscopy (n=24) were compared to a residents group (n=16). Analyzed parameters were “time to complete a task,” assessment of the movement of tools and values scoring damage to the surrounding tissues. Results After several repetitions, both groups improved their skills in terms of time and movement. Residents were on average faster, had less camera movement, and touched the cartilage tissue less often than did students. Students showed a steeper improvement curve than residents for certain parameters, as they started from a different experience level. Conclusion The participants were able to reduce the time to complete a task. There was also a decrease in possible damage to the virtual surrounding tissues. In general, the residents had better mean values, but the students had the steeper learning curve. Particularly less experienced surgeons can especially train their hand–eye coordination skills required for arthroscopy surgery. Training simulators are an important training tool that supplements cadaveric training and participation in arthroscopic operations and should be included in training.
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Affiliation(s)
- David Putzer
- Department of Orthopaedics and Traumatology – Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
- David Putzer, Department of Orthopaedics and Traumatology - Experimental Orthopaedics, Experimental Orthopedics, Medical University of Innsbruck, Sonnenburgstrasse 16, Innsbruck 6020, Austria.
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martina Baldauf
- Department of Orthopaedics and Traumatology – Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Lenze
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael C. Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Nogler
- Department of Orthopaedics and Traumatology – Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
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Baxter JA, Bhamber NS, Patel RS, Tennent D. The FAST Workstation Shows Construct Validity and Participant Endorsement. Arthrosc Sports Med Rehabil 2021; 3:e1133-e1140. [PMID: 34430894 PMCID: PMC8365199 DOI: 10.1016/j.asmr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/22/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine in what way the proposed simulation-based intervention (SBI) is an effective intervention for use in basic arthroscopic skills training. Methods Twenty candidates were recruited and grouped according to experience. Performance metrics included the time to activity completion, errors made, and Global Rating Scale score. Qualitative data were collected using a structured questionnaire. Results Performance on the SBI differed depending on previous arthroscopic training received. Performance on the simulator differed between groups to a statistically significant level regarding time to completion. A difference was also present between participants with no previous training and those with previous training when assessed using the Global Rating Scale. The SBI was deemed acceptable, user-friendly, and realistic. Participants practicing at the expert level believe that such an SBI would be beneficial in developing basic arthroscopic skills. Conclusions The results of this study provide evidence that the use of an SBI consisting of a benchtop workstation, laptop viewing platform, 30° arthroscope, and defined performance metrics can detect differences in the level of arthroscopic experience. This format of SBI has been deemed acceptable and useful to the intended user, increasing the feasibility of introducing it into surgical training. Clinical Relevance This study adds to the existing body of evidence supporting the potential benefits of benchtop SBIs in arthroscopic skills training. Improved performance on such an SBI may be beneficial for the purpose of basic arthroscopic skills training, and we would support the inclusion of this system in surgical training programs such as those developed by the Arthroscopy Association of North America and American Board of Orthopaedic Surgery.
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Affiliation(s)
- Jonathan A Baxter
- Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury, England
| | - Nivraj S Bhamber
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, England
| | - Rakesh S Patel
- School of Medicine, University of Nottingham, Nottingham, England
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22
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Samaratunga R, Johnson L, Gatzidis C, Swain I, Wainwright T, Middleton R. A review of participant recruitment transparency for sound validation of hip surgery simulators: a novel umbrella approach. J Med Eng Technol 2021; 45:434-456. [PMID: 34016011 DOI: 10.1080/03091902.2021.1921868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Malposition of implants is associated with complications, higher wear and increased revision rates in total hip replacement (THR) along with surgeon inexperience. Training THR residents to reach expert proficiency is affected by the high cost and resource limitations of traditional training techniques. Research in extended reality (XR) technologies can overcome such barriers. These offer a platform for learning, objective skill-monitoring and, potentially, for automated certification. Prior to their incorporation into curricula however, thorough validation must be undertaken. As validity is heavily dependent on the participants recruited, there is a need to review, scrutinise and define recruitment criteria in the absence of pre-defined standards, for sound simulator validation. A systematic review on PubMed and IEEE databases was conducted. Training simulator validation research in fracture, arthroscopy and arthroplasty relating to the hip was included. 46 validation studies were reviewed. It was observed that there was no uniformity in reporting or recruitment criteria, rendering cross-comparison challenging. This work developed Umbrella categories to help prioritise recruitment, and has formulated a detailed template of fields and guidelines for reporting criteria so that, in future, research may come to a consensus as to recruitment criteria for a hip "expert" or "novice".
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Affiliation(s)
| | - Layla Johnson
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - Christos Gatzidis
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - Ian Swain
- Faculty of Science and Technology, Bournemouth University, Poole, UK.,Orthopaedic Research Institute, Bournemouth University, UK
| | - Thomas Wainwright
- Orthopaedic Research Institute, Bournemouth University, UK.,University Hospitals Dorset NHS Foundation Trust, UK
| | - Robert Middleton
- Orthopaedic Research Institute, Bournemouth University, UK.,University Hospitals Dorset NHS Foundation Trust, UK
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23
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Kulcheski ÁL, Stieven-Filho E, Nunes CP, Milcent PAA, Dau L, I-Graells XS. Validation of an endoscopic flavectomy training model. Rev Col Bras Cir 2021; 48:e202027910. [PMID: 33978123 PMCID: PMC10683459 DOI: 10.1590/0100-6991e-20202901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to validate a lumbar spine endoscopic flavectomy simulator using the construct method and to assess the acceptability of the simulator in medical education. METHODS thirty medical students and ten video-assisted surgery experienced orthopedists performed an endoscopic flavectomy procedure in the simulator. Time, look-downs, lost instruments, respect for the stipulated edge of the ligamentum flavum, regularity of the incision, GOALS checklist (Global Operative Assessment of Laparoscopic Skills), and responses to the Likert Scale adapted for this study were analyzed. RESULTS all variables differed between groups. Procedure time was shorter in the physician group (p < 0.001). Look-downs and instrument losses were seven times greater among students than physicians. Half of the students respected the designated incision limits, compared to 80% of the physicians. In the student group, about 30% of the incisions were regular, compared to 100% in the physician group (p < 0.001). The physicians performed better in all GOALS checklist domains. All the physicians and more than 96% of the students considered the activity enjoyable, and approximately 90% believed that the model was realistic and could contribute to medical education. CONCLUSIONS the simulator could differentiate the groups' experience level, indicating construct validity, and both groups reported high acceptability.
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Affiliation(s)
- Álynson Larocca Kulcheski
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Edmar Stieven-Filho
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Carolline Popovicz Nunes
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Paul André Alain Milcent
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Leonardo Dau
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Xavier Soler I-Graells
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
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Luceri F, Arrigoni P, Barco R, Cucchi D, Raj N, Frassoni S, Randelli PS. Does Sawbone-Based Arthroscopy Module (SBAM) Can Help Elbow Surgeons? Indian J Orthop 2021; 55:182-188. [PMID: 34113427 PMCID: PMC8149533 DOI: 10.1007/s43465-020-00133-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The use of elbow arthroscopy is becoming increasingly common in orthopaedic practice; nevertheless, it is still considered a difficult procedure with a long learning curve. The aim of the study is to evaluate the role of a new elbow Sawbone-Based Arthroscopy Module (e-SBAM) in the training of elbow surgeons. METHODS Fourteen surgeons were classified as "Expert" (n: 7; more than 10 years of experience in arthroscopic surgery) and "Not-expert" surgeons (n: 7; less than 10 years of experience). During a dedicated arthroscopic session, using the Sawbones Elbow model (Sawbones Europe AB®), all participants were asked to perform an arthroscopic round and to touch three specific landmarks. An independent observer measured the time that each participant needed to perform this task (Performance 1). The same measurement was repeated after two weeks of eSBAM training (Performance 2). RESULTS "Not-expert" surgeons needed significantly more time (41 s; range 26-120) than "Expert" ones (13 s; range 8-36) to complete Performance 1. One "Not-expert" surgeon did not complete Performance 1 and needed more than 120 s for Performance 2. The whole study group required a median of 5 s less to complete Performance 2. A tendency towards an improvement was observed in the group of the non-experienced surgeons as compared with the experienced ones. CONCLUSIONS The simulation training can be advantageous in the learning curve of young elbow surgeons and helpful for experienced surgeons. E-SBAM can be used as an effective tool for the current stepwise arthroscopic elbow training programs with the aim of improving arthroscopic elbow skills. LEVEL OF EVIDENCE Basic Science Study.
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Affiliation(s)
- Francesco Luceri
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Paolo Arrigoni
- U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Raul Barco
- Shoulder and Elbow Unit, Hospital Universitario la Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Davide Cucchi
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Nishant Raj
- Krishna Hospital and Trauma Centre, Patel Nagar Ghaziabad, Uttar Pradesh 201001 India
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Pietro Simone Randelli
- U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Jassim SS, Varma SK, Ramachandran M, Akhtar KSN. Survey of trainee attitudes to skill development and simulation training in
trauma and orthopaedics. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:154-158. [DOI: 10.1136/bmjstel-2020-000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 11/03/2022]
Abstract
Background
Simulation training in surgery is widespread and allows surgeons to
practise novel operative techniques and acquaint themselves with unfamiliar
surgical procedures. The use of box or virtual reality simulators in many
surgical specialities is established; however, its use within trauma and
orthopaedics (T&O) in the UK and the attitudes of trainee towards it are
not known. The aim of this study is to explore the experiences and opinions of
T&O trainees towards simulation training.
Methods
An electronic survey consisting of 11 questions on the experiences of
simulation training and attitudes towards it was sent to all T&O speciality
trainees in London.
Results
Fewer than 10% of the responders had used or had ready access to
simulators to prepare for unfamiliar operations, with almost 90% preferring to
read about them in a journal or watch them on an online video site. Over half
had only seen simulators on courses or been aware of them. Over 75% of the
responders believed that simulators should be available for trainees, but most
did not feel that they should be used as part of formal assessments.
Conclusions
Methods for preparing for new operations have expanded over the past
20 years, yet the use of simulator machines is not widespread. Many trainees
believe current machines are not widely available nor realistic enough to be
useful, with most preferring online videos and operative technique books for
preparing for an unfamiliar operation.
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Otlans PT, Buuck T, Rosencrans A, Brady JM. Orthopaedic Resident Arthroscopic Knot-Tying Skills Are Improved Using a Training Program and Knot-Tying Workstation. Arthrosc Sports Med Rehabil 2021; 3:e867-e871. [PMID: 34195656 PMCID: PMC8220621 DOI: 10.1016/j.asmr.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To quantify an orthopaedic trainee’s ability to tie arthroscopic knots before and after a short cadaveric-based arthroscopy training period using a commercially available knot-tying workstation. Methods During a weeklong cadaveric arthroscopic training camp, 15 third- and fourth-year orthopaedic residents were evaluated using a commercially available benchtop knot-tying workstation. At the beginning of the week (baseline), each participant was asked to tie 3 knots of his or her choice backed up by 3 half-hitches using nonabsorbable suture. Successful knots fit the sizer and elongated less than 3 mm after application of a 15-lb load. Afterward, residents watched a video demonstrating a sample knot and were encouraged to practice over the ensuing days. At the end of the week (post-training), residents were asked to tie 3 knots. The time to completion and success of each knot were recorded. To compare baseline and post-training knot success, t tests and χ2 analysis were performed. Results During baseline testing, residents successfully tied 26.7% of their knots (12 of 45 knots) in 352 ± 116 seconds (mean ± standard deviation). During post-training testing, residents successfully tied 66.7% of knots (30 of 45 knots, P = .00014) in 294 ± 63 seconds (P = .023), showing significant improvement in the time and ability to tie arthroscopic knots. Conclusions With a short cadaveric-based training period, orthopaedic trainees showed a significant improvement in their ability to tie arthroscopic knots on a commercially available benchtop knot-tying workstation. Given the initial low percentage of successfully tied knots and the limited opportunities for trainees to improve, trainees should be encouraged to practice and improve their skills. Clinical Relevance With training, residents can improve arthroscopic knot-tying abilities, which may allow them to successfully perform this critical task in the operating room.
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Affiliation(s)
- Peters T Otlans
- School of Medicine, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Taylor Buuck
- School of Medicine, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Adam Rosencrans
- School of Medicine, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Jacqueline M Brady
- School of Medicine, Oregon Health & Science University, Portland, Oregon, U.S.A
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Cognitive Training in Orthopaedic Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00004. [PMID: 33720112 PMCID: PMC7954369 DOI: 10.5435/jaaosglobal-d-21-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 12/29/2022]
Abstract
Over the past two decades, various factors have led to fewer opportunities for hands-on learning in the operating room among orthopaedic surgery trainees. Innovative training platforms using anatomic models, cadaveric specimens, and augmented reality have been devised to address this deficiency in surgical training, but such training tools are often costly with limited accessibility. Cognitive training is a low-cost training technique that improves physical performance by refining the way in which information is mentally processed and has long been used by professional athletes and world-class musicians. More recently, cognitive training tools have been developed for several orthopaedic surgery procedures, but the overall utility of cognitive training in orthopaedic surgery remains unknown.
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Luzzi A, Hellwinkel J, O'Connor M, Crutchfield C, Lynch TS. The Efficacy of Arthroscopic Simulation Training on Clinical Ability: A Systematic Review. Arthroscopy 2021; 37:1000-1007.e1. [PMID: 33220467 DOI: 10.1016/j.arthro.2020.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the effect of arthroscopic simulator training on technical performance in a human model. METHODS A systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches of PubMed, Embase, and Cochrane Library were conducted using combinations of the terms virtual, digital, computer, reality, simulation, arthroscopy, training, learning, and education. Studies were considered for inclusion if they tested the effect of arthroscopic simulator training in a randomized controlled fashion, performed testing in a cadaver or live patient, and used explicit outcome measures of technical skill. Data from studies were extracted and study characteristics and outcomes were reviewed. The primary outcome measure was the number of studies in which the simulation trained group had significantly improved performance results relative to the control group in ≥50% of all measured outcomes. Risk of bias was assessed with Cochrane's Collaboration Tool. RESULTS Twelve studies, including 340 total study participants, were included for review. Eight studies showed improved performance of the simulation trained group relative to the control group in ≥50% of assessed outcomes. Six of ten studies reporting completion time, three of six studies reporting task checklist completion, 3 of 7 studies reporting global rating scales, and 1 of 4 studies reporting Arthroscopic Surgical Skill Evaluation Tool scores showed improved performance of the simulation group relative to the control group for the respective outcome measures. CONCLUSIONS The literature is limited due to heterogeneity, both in type and merit, of the outcome measures that have been used to assess the transfer validity of arthroscopic simulator training to clinical performance. Despite the limitations of the literature, this review demonstrates that arthroscopic simulator training has potential to improve clinical performance. LEVEL OF EVIDENCE II, systematic review of Level II studies.
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Affiliation(s)
- Andrew Luzzi
- Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Justin Hellwinkel
- Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Michaela O'Connor
- Columbia University Irving Medical Center, New York, New York, U.S.A
| | | | - T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, U.S.A..
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Iqbal MH, Khan O, Aydın A. Editorial Commentary: Simulation-Based Training in Orthopaedic Surgery: Current Evidence and Limitations. Arthroscopy 2021; 37:1008-1010. [PMID: 33673956 DOI: 10.1016/j.arthro.2020.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
Simulation-based training has been widely adopted by surgical educators and is now an essential component of the modern resident's skills acquisition pathway and career progression. The challenges faced by residents because of lack of exposure as a result of working-time directives-and now the COVID-19 (coronavirus disease 2019) pandemic limiting nonurgent and elective operating-reinforce the need for evidence-based simulation training. Although a wide range of training platforms have been developed, very few have shown transfer of skills. Simulation is thought to enhance the initial phase of the procedural learning curve; however, this hypothesis is yet to be tested in a high-quality study. Nevertheless, in light of the current evidence, simulation-based procedural curricula should be developed using the strengths of multiple different training platforms while incorporating the essential concept of nontechnical skills.
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Petersen W, Hees T, Ohde J. Aktueller Stand virtueller Simulatoren für die chirurgische Ausbildung in Orthopädie und Unfallchirurgie. ARTHROSKOPIE 2021. [PMCID: PMC7793396 DOI: 10.1007/s00142-020-00429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Die praktische chirurgische Ausbildung wird in der Orthopädie und Unfallchirurgie durch den steigenden Kostendruck in den Kliniken sowie die Verlagerung vieler Operationen in den ambulanten Bereich immer schwieriger. Das betrifft besonders die Arthroskopie, die zudem hohe Anforderungen an die Fähigkeiten des Operateurs stellt. In den letzten 20 Jahren wurden daher zahlreiche Arthroskopiesimulatoren entwickelt. Dabei handelt es sich um virtuelle Desktopsysteme, die mit einem Gelenksimulator gekoppelt sind und eine taktile Rückkopplung erlauben. Auf diese Weise können arthroskopische Basisfähigkeiten (z. B. Triangulation) oder auch arthroskopische Operationen (z. B. partielle Meniskektomie) trainiert werden. Die Systeme ermöglichen eine Erfolgskontrolle durch die Erfassung verschiedener Parameter (Operationszeit, Kamera‑/Instrumentenpfadlänge, Knorpelberührungen). Es existieren bereits Simulatoren für alle großen Gelenke. Mittlerweile liegen Daten zur Augenscheinvalidität, Inhaltsvalidität, Konstruktvalidität und zur Transfervalidität dieser Systeme vor. Die erlernten Fähigkeiten lassen sich daher auf den Erfolg im Operationssaal übertragen. Ungelöst ist bisher die Kosteneffizienz dieser Systeme. Von den Desktop-Gelenkmodell-Systemen müssen immersive Virtual-Reality(VR)-Systeme unter Verwendung von 3‑D-Brillen und taktilen Handsensoren abgegrenzt werden. Der Teilnehmende tritt der Applikation dabei meist als Avatar bei. Daher eignen sich immersive Systeme besonders zur Simulation offener Operationen (z. B. Hüftendoprothetik). Erste Studien haben auch für den Einsatz der immersiven virtuellen Realität Evidenz für Inhalts‑, Konstrukt- und Transfervalidität beim Training verschiedener offener Operationen gezeigt. Hier sind in Zukunft weitere Entwicklungen zu erwarten.
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Milcent PAA, Kulcheski AL, Rosa FM, Dau L, Stieven Filho E. Construct Validity and Experience of Using a Low-cost Arthroscopic Knee Surgery Simulator. JOURNAL OF SURGICAL EDUCATION 2021; 78:292-301. [PMID: 32591322 DOI: 10.1016/j.jsurg.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/31/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To validate an affordable and easily reproducible arthroscopic knee surgery simulator made from simple, low-cost materials by demonstrating its ability to distinguish experienced from novice arthroscopists (i.e., construct validity). Additionally, acceptance and usefulness of the simulator in medical training and education were assessed. DESIGN The simulator was used to perform a partial meniscectomy in both menisci. External and intra-articular images obtained during the procedures were used to assess objective visual parameters. The Arthroscopic Surgical Skill Evaluation Tool and a Likert scale addressing individual perceptions about the simulator and its applicability in medical education were also used. SETTING The study was conducted at Hospital de Clínicas da Universidade Federal do Paraná, a teaching hospital in southern Brazil. PARTICIPANTS Thirty sixth-year medical students were recruited, as well as 10 orthopedic surgeons who had knee arthroscopy expertise and were members of a sports traumatology and knee arthroscopy group. RESULTS There were statistically significant differences between the groups in all objective parameters. The mean time to perform the procedure was 60% higher among students compared to surgeons. Students needed 72.5% more time on average to perform triangulations and obtained an error rate approximately twice higher in the assessment of the area removed from the menisci. Regarding Arthroscopic Surgical Skill Evaluation Tool scores, statistically significant differences were found between surgeons and students in all 8 domains and in the total score. The simulator was well accepted, as over 90% of participants found it useful for education and training, believed it contributed to teaching and assessing specific surgical steps and procedures, and reported that the task was enjoyable. CONCLUSIONS The arthroscopic knee surgery simulator was largely accepted and had good applicability in objective measurement of surgical skills, distinguishing medical students from orthopedic surgeons and thus demonstrating construct validity.
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Affiliation(s)
- Paul André Alain Milcent
- Graduate Program in Clinical Surgery, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
| | | | - Fernando Martins Rosa
- Graduate Program in Clinical Surgery, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Leonardo Dau
- Graduate Program in Clinical Surgery, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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Efficacy and Validity of Orthopaedic Simulators in Surgical Training: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Acad Orthop Surg 2020; 28:1027-1040. [PMID: 32398408 DOI: 10.5435/jaaos-d-19-00839] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The purpose of this study was to perform a systematic review and meta-analysis of the effects of training simulators on surgical skill measures across randomized controlled trials. The authors hypothesized that simulated training would (1) result in objective improvements in skill acquisition and (2) be heterogeneous regarding the outcomes and types of validity assessed. METHODS The Cochrane Database of Systematic Reviews, the Central Register of Controlled Trials, PubMed, EMBASE, and MEDLINE databases were queried for Level I studies on training simulators between 2007 and 2019 in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Exclusion criteria were studies without discrete assessment of skills acquisition after surgical simulator training and level of evidence II to V. The Jadad scale was used to assess the methodological quality of all included articles. Data pertaining to patient demographics, validity measures, simulator types, and study-specific outcome measures were extracted. Meta-analyses adjusted for random effects and heterogeneity analyses (I) were used to compare pooled time-to-completion and performance outcomes among included studies. RESULTS A total of 24 studies with 494 participants were identified. The most common simulator type involved knee arthroscopy (11 studies, 45.8%). Eight studies reporting time-to-task completion and performance scores were included in the meta-analysis. Virtual reality training was favored in time-to-task completion (mean difference = -82.25 seconds, P = 0.002) and improvement in objective performance scores (mean difference = 1.24, P = 0.02) relative to traditional training. Sensitivity analysis of time-to-task completion based on the length of training interval revealed a mean difference of -45.24 (P = 0.07) and -137.74 (P < 0.001) seconds for the short-term and immediate posttesting subgroups, respectively. CONCLUSION Overall, improved task efficiency and performance were observed with the use of orthopaedic simulators. However, simulator type, training protocols, and outcome measures were heterogeneous. Future studies are warranted to evaluate financial cost and longitudinal training programs and to standardize outcomes regarding the use of simulators in orthopaedic education. LEVEL OF EVIDENCE Level I.
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Rölfing JD, Jensen RD, Paltved C. HipSim - hip fracture surgery simulation utilizing the Learning Curve-Cumulative Summation test (LC-CUSUM). Acta Orthop 2020; 91:669-674. [PMID: 32539590 PMCID: PMC8023956 DOI: 10.1080/17453674.2020.1777511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Virtual reality simulation of hip fracture surgery is available for orthopedic residents nationwide in Denmark. Summative assessment of learning applying the learning curve cumulative summation test (LC-CUSUM) has not been utilized in orthopedic simulation training. The strength of the LC-CUSUM is that it assumes incompetency and signals competency based on solid statistics. We investigated the LC-CUSUM characteristics of novices stepwise mastering the simulated dynamic hip screw (DHS) procedure. Material and methods - 32 1st-year orthopedic residents participated in HipSim and its 3 subsequent LC-CUSUM evaluations: placing a Kirschner wire, placing a Kirschner wire in different patients, and performing the entire DHS procedure in different patients. The career status of the participants, i.e., still working in orthopedics or in another specialty was recorded ≥ 2 years after participation and associated with the simulation performance (passed/failed). Results - 13/14 participants passing HipSim according to LC-CUSUM were still working in orthopedics, while 9/18 participants failing HipSim had quit orthopedics at ≥ 2 years follow-up. The simulator-generated feedback did not statistically significantly differ between the groups. Interpretation - LC-CUSUM and its summative pass/fail assessment of each simulation was feasible in this formative simulation program. Clinical educators can be reassured that participants passing HipSim are likely to continue to 2nd-5th year of residency, while failing HipSim should raise concerns and trigger career counselling and clinical supervision. The motivational aspect of LC-CUSUM pass/fail assessment when designing formative simulation training warrants further research.
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Affiliation(s)
- Jan Duedal Rölfing
- Corporate HR, MidtSim, Central Denmark Region,Department of Clinical Medicine, Aarhus University,Department of Orthopaedics, Aarhus University Hospital, Denmark,Correspondence:
| | - Rune Dall Jensen
- Corporate HR, MidtSim, Central Denmark Region,Department of Clinical Medicine, Aarhus University
| | - Charlotte Paltved
- Corporate HR, MidtSim, Central Denmark Region,Department of Clinical Medicine, Aarhus University
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Lee R, Raison N, Lau WY, Aydin A, Dasgupta P, Ahmed K, Haldar S. A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology. Eye (Lond) 2020; 34:1737-1759. [PMID: 32203241 PMCID: PMC7609318 DOI: 10.1038/s41433-020-0832-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/23/2019] [Accepted: 01/05/2020] [Indexed: 12/27/2022] Open
Abstract
To evaluate all simulation models for ophthalmology technical and non-technical skills training and the strength of evidence to support their validity and effectiveness. A systematic search was performed using PubMed and Embase for studies published from inception to 01/07/2019. Studies were analysed according to the training modality: virtual reality; wet-lab; dry-lab models; e-learning. The educational impact of studies was evaluated using Messick's validity framework and McGaghie's model of translational outcomes for evaluating effectiveness. One hundred and thirty-one studies were included in this review, with 93 different simulators described. Fifty-three studies were based on virtual reality tools; 47 on wet-lab models; 26 on dry-lab models; 5 on e-learning. Only two studies provided evidence for all five sources of validity assessment. Models with the strongest validity evidence were the Eyesi Surgical, Eyesi Direct Ophthalmoscope and Eye Surgical Skills Assessment Test. Effectiveness ratings for simulator models were mostly limited to level 2 (contained effects) with the exception of the Sophocle vitreoretinal surgery simulator, which was shown at level 3 (downstream effects), and the Eyesi at level 5 (target effects) for cataract surgery. A wide range of models have been described but only the Eyesi has undergone comprehensive investigation. The main weakness is in the poor quality of study design, with a predominance of descriptive reports showing limited validity evidence and few studies investigating the effects of simulation training on patient outcomes. More robust research is needed to enable effective implementation of simulation tools into current training curriculums.
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Affiliation(s)
- Roxanne Lee
- GKT School of Medical Education, King's College London, London, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, King's College London, London, UK
| | - Wai Yan Lau
- School of Medicine, St George's, University of London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, UK
| | - Shreya Haldar
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK.
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Ahmed TM, Hussain B, Siddiqui MAR. Can simulators be applied to improve cataract surgery training: a systematic review. BMJ Open Ophthalmol 2020; 5:e000488. [PMID: 32953997 PMCID: PMC7481074 DOI: 10.1136/bmjophth-2020-000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/29/2020] [Accepted: 08/13/2020] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of this paper was to conduct a systematic review of existing literature on simulation-based training of cataract surgery. Available literature was evaluated and projections on how current findings could be applied to cataract surgery training were summarised. The quality of included literature was also assessed. Methods and analysis The PubMed, Embase and Cochrane Library databases were searched for articles pertaining to simulation training in cataract surgery on 18 November 2019. Selected articles were qualitatively analysed. Results A total of 165 articles were identified out of which 10 met inclusion criteria. Four studies reported construct validity of the EyeSi simulator. Six studies demonstrated improved surgical outcomes corresponding to training on the simulator. Quality assessment of included studies was satisfactory. Conclusion Current studies on simulation training in cataract surgery all point towards it being an effective training tool with low risk of study biases confounding this conclusion. As technology improves, surgical training must embrace and incorporate simulation technology in training.
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Affiliation(s)
| | - Badrul Hussain
- Cataract Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - M A Rehman Siddiqui
- Department of Surgery, Section of Ophthalmology, Aga Khan University Hospital, Karachi, Pakistan
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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Aydin A, Ahmed K, Van Hemelrijck M, Ahmed HU, Khan MS, Dasgupta P. Simulation in Urological Training and Education (SIMULATE): Protocol and curriculum development of the first multicentre international randomized controlled trial assessing the transferability of simulation-based surgical training. BJU Int 2020; 126:202-211. [PMID: 32189446 DOI: 10.1111/bju.15056] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To report the study protocol for the first international multicentre randomized controlled trial investigating the effectiveness of simulation-based surgical training and the development process for an evidence-based training curriculum, to be delivered as an educational intervention. PARTICIPANTS AND METHODS This prospective, international, multicentre randomized controlled clinical and educational trial will recruit urology surgical trainees who must not have performed ≥10 of the selected index procedure, ureterorenoscopy (URS). Participants will be randomized to simulation-based training (SBT) or non-simulation-based training (NSBT), the latter of which is the current sole standard of training globally. The primary outcome is the number of procedures required to achieve proficiency, where proficiency is defined as achieving a learning curve plateau of 28 or more on an Objective Structured Assessment of Technical Skills (OSATS) assessment scale, for three consecutive operations, without any complications. All participants will be followed up either until they complete 25 procedures or for 18 months. Development of the URS SBT curriculum took place through a two-round Delphi process. RESULTS A total of 47 respondents, consisting of trainees (n = 24) with URS experience and urolithiasis specialists (n = 23), participated in round 1 of the Delphi process. Specialists (n = 10) finalized the content of the curriculum in round 2. The developed interventional curriculum consists of initial theoretic knowledge through didactic lectures followed by select tasks and cases on the URO-Mentor (Simbionix, Lod, Israel) VR Simulator, Uro-Scopic Trainer (Limbs & Things, Bristol, UK) and Scope Trainer (Mediskills, Manchester, UK) models for both semi-rigid and flexible URS. Respondents also selected relevant non-technical skills scenarios and cadaveric simulation tasks as additional components, with delivery subject to local availability. CONCLUSIONS SIMULATE is the first multicentre trial investigating the effect and transferability of supplementary SBT on operating performance and patient outcomes. An evidence-based training curriculum is presented, developed with expert and trainee input. Participants will be followed and the primary outcome, number of procedures required to proficiency, will be reported alongside key clinical secondary outcomes, (ISCRTN 12260261).
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Affiliation(s)
- Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Hashim U Ahmed
- Department of Surgery and Cancer, Imperial College London, UK.,Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Abstract
Virtual Reality (VR) in orthopedic surgery has significantly increased in popularity in the areas of preoperative planning, intraoperative usage, and for education and training; however, its utilization lags behind other surgical disciplines and industries. The use of VR in orthopedics is largely focused on education and is currently endorsed by North American and European training committees. The use of VR in shoulder and elbow surgery has varying levels of evidence, from I to IV, and typically involves educational randomized controlled trials. To date, however, the terms and definitions surrounding VR technology used in the literature are often redundant, confusing, or outdated. The purpose of this review, therefore, was to characterize previous uses of VR in shoulder and elbow surgery in preoperative, intraoperative, and educational domains including trauma and elective surgery. Secondary objectives were to provide recommendations for updated terminology of immersive VR (iVR) as well as provide a framework for standardized reporting of research surrounding iVR in shoulder and elbow surgery.
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Affiliation(s)
- Ryan Lohre
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Jon J P Warner
- The Harvard Shoulder Service, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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Al-Jabir A, Aydin A, Al-Jabir H, Khan MS, Dasgupta P, Ahmed K. Current status of wet lab and cadaveric simulation in urological training: A systematic review. Can Urol Assoc J 2020; 14:E594-E600. [PMID: 32520706 DOI: 10.5489/cuaj.6520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We undertook a systematic review of the use of wet lab (animal and cadaveric) simulation models in urological training, with an aim to establishing a level of evidence (LoE) for studies and level of recommendation (LoR) for models, as well as evaluating types of validation. METHODS Medline, EMBASE, and Cochrane databases were searched for English-language studies using search terms including a combination of "surgery," "surgical training," and "medical education." These results were combined with "wet lab," "animal model," "cadaveric," and "in-vivo." Studies were then assigned a LoE and LoR if appropriate as per the education-modified Oxford Centre for Evidence-Based Medicine classification. RESULTS A total of 43 articles met the inclusion criteria. There was a mean of 23.1 (±19.2) participants per study with a median of 20. Overall, the studies were largely of low quality, with 90.7% of studies being lower than LoE 2a (n=26 for LoE 2b and n=13 for LoE 3). The majority (72.1%, n=31) of studies were in animal models and 27.9% (n=12) were in cadaveric models. CONCLUSIONS Simulation in urological education is becoming more prevalent in the literature, however, there is a focus on animal rather than cadaveric simulation, possibly due to cost and ethical considerations. Studies are also predominately of a low LoE; higher LoEs, especially randomized controlled studies, are needed.
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Affiliation(s)
- Ahmed Al-Jabir
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Hussain Al-Jabir
- William Harvey Research Institute, Barts and The London School of Medicine School of Medicine and Dentistry, London, United Kingdom
| | - M Shamim Khan
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.,Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Lohre R, Bois AJ, Athwal GS, Goel DP. Improved Complex Skill Acquisition by Immersive Virtual Reality Training: A Randomized Controlled Trial. J Bone Joint Surg Am 2020; 102:e26. [PMID: 31972694 DOI: 10.2106/jbjs.19.00982] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been limited literature on immersive virtual reality (VR) simulation in orthopaedic education. The purpose of this multicenter, blinded, randomized controlled trial was to determine the validity and efficacy of immersive VR training in orthopaedic resident education. METHODS Nineteen senior orthopaedic residents (resident group) and 7 consultant shoulder arthroplasty surgeons (expert group) participated in the trial comparing immersive VR with traditional learning using a technical journal article as a control. The examined task focused on achieving optimal glenoid exposure. Participants completed demographic questionnaires, knowledge tests, and a glenoid exposure on fresh-frozen cadavers while being examined by blinded shoulder arthroplasty surgeons. Training superiority was determined by the outcome measures of the Objective Structured Assessment of Technical Skills (OSATS) score, a developed laboratory metric, verbal answers, and time to task completion. RESULTS Immersive VR had greater realism and was superior in teaching glenoid exposure than the control (p = 0.01). The expert group outperformed the resident group on knowledge testing (p = 0.04). The immersive VR group completed the learning activity and knowledge tests significantly faster (p < 0.001) at a mean time (and standard deviation) of 11 ± 3 minutes than the control group at 20 ± 4 minutes, performing 3 to 5 VR repeats for a reduction in learning time of 570%. The immersive VR group completed the glenoid exposure significantly faster (p = 0.04) at a mean time of 14 ± 7 minutes than the control group at 21 ± 6 minutes, with superior OSATS instrument handling scores (p = 0.03). The immersive VR group scored equivalently in surprise verbal scores (p = 0.85) and written knowledge scores (p = 1.0). CONCLUSIONS Immersive VR demonstrated substantially improved translational technical and nontechnical skills acquisition over traditional learning in senior orthopaedic residents. Additionally, the results demonstrate the face, content, construct, and transfer validity for immersive VR. CLINICAL RELEVANCE This adequately powered, randomized controlled trial demonstrated how an immersive VR system can efficiently (570%) teach a complex surgical procedure and also demonstrate improved translational skill and knowledge acquisition when compared with a traditional learning method.
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Affiliation(s)
- Ryan Lohre
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Orthopaedic Residents' Transfer of Knee Arthroscopic Abilities from the Simulator to the Operating Room. J Am Acad Orthop Surg 2020; 28:194-199. [PMID: 31415299 DOI: 10.5435/jaaos-d-19-00245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The ultimate goal for any surgical simulation program is to prove the capability of transferring the skills learned to real-life surgical scenarios. We designed an arthroscopic partial meniscectomy (APM) training program and sought to determine its ability to transfer skills to real patients. METHODS Eleven junior orthopaedic residents and three expert knee surgeons were included. A low-fidelity knee simulator was used. Trainees had two baseline assessments of completing APM on a supervised real patient and on the simulator, measured using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). After baseline, the trainees completed an APM training program and had a final evaluation of proficiency on the simulator and in real patients. Experts were also assessed for comparison. Statistical analysis was performed, assuming nonparametric behavior of variables. RESULTS All trainees improved from a base score of 14 points in real patients and 10 points on the simulator to a final score of 39 points and 36 points, respectively (P < 0.01). The final trainee simulator score did not differ from experts on the simulator and was lower in real patients (36 versus 39 points, respectively, P ≤ 0.01), which resulted in a 92% transfer ratio for the simulator. DISCUSSION Simulated training of APM in orthopaedic residents using a low-fidelity knee simulator proved to not only improve simulated proficiency but also successfully transfer skills to a real clinical scenario with a high model transfer ratio. LEVEL OF EVIDENCE Level II (Prospective Cohort Study).
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Patel EA, Aydin A, Cearns M, Dasgupta P, Ahmed K. A Systematic Review of Simulation-Based Training in Neurosurgery, Part 2: Spinal and Pediatric Surgery, Neurointerventional Radiology, and Nontechnical Skills. World Neurosurg 2020; 133:e874-e892. [DOI: 10.1016/j.wneu.2019.08.263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
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Valsamis EM, Sukeik M. Evaluating learning and change in orthopaedics: What is the evidence-base? World J Orthop 2019; 10:378-386. [PMID: 31840018 PMCID: PMC6908444 DOI: 10.5312/wjo.v10.i11.378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/27/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023] Open
Abstract
Learning and change are key elements of clinical governance and are responsible for the progression of our specialty. Although orthopaedics has been slow to embrace quality improvement, recent years have seen global developments in surgical education, quality improvement, and patient outcome research. This review covers recent advances in the evaluation of learning and change and identifies the most important research questions that remain unanswered. Research into proxies of learning is improving but more work is required to identify the best proxy for a given procedure. Learning curves are becoming commonplace but are poorly integrated into postgraduate training curricula and there is little agreement over the most appropriate method to analyse learning curve data. With various organisations promoting centralisation of care, learning curve analysis is more important than ever before. The use of simulation in orthopaedics is developing but is yet to be formally mapped to resident training worldwide. Patient outcome research is rapidly changing, with an increased focus on quality of life measures. These are key to patients and their care. Cost-utility analysis is increasingly seen in orthopaedic manuscripts and this needs to continue to improve evidence-based care. Large-scale international, multi-centre randomised trials are gaining popularity and updated guidance on sample size estimation needs to become widespread. A global lack of surgeon equipoise will need to be addressed. Quality improvement projects frequently employ interrupted time-series analysis to evaluate change. This technique's limitations must be acknowledged, and more work is required to improve the evaluation of change in a dynamic healthcare environment where multiple interventions frequently occur. Advances in the evaluation of learning and change are needed to drive improved international surgical education and increase the reliability, validity, and importance of the conclusions drawn from orthopaedic research.
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Affiliation(s)
| | - Mohamed Sukeik
- Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital – Al Khobar, King Salman Bin Abdulaziz Rd, Al Bandariyah, Al Khobar 34423, Saudi Arabia
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Gustafsson A, Viberg B, Paltved C, Palm H, Konge L, Nayahangan LJ. Identifying Technical Procedures in Orthopaedic Surgery and Traumatology That Should Be Integrated in a Simulation-Based Curriculum: A National General Needs Assessment in Denmark. J Bone Joint Surg Am 2019; 101:e108. [PMID: 31626016 DOI: 10.2106/jbjs.18.01122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Simulation-based training is emerging within the orthopaedic field to alleviate the challenges that trainees face such as work-hour restrictions, limited exposure to procedures, and increasing pressures to reduce risk to patients. This training modality has grown increasingly popular over the last 2 decades. However, integration into the curriculum often fails to follow a structured educational plan. The development of simulation-based curricula should follow a structured and stepwise approach that starts with a general needs assessment. This study aimed to identify and prioritize procedures within orthopaedic surgery to be included in a simulation-based curriculum on a national basis. METHODS A national needs assessment was conducted using the Delphi method. Ninety-five experts who are involved in the training of orthopaedic surgeons from all orthopaedic departments in Denmark were selected to participate in the assessment. Round 1 was a brainstorming phase to identify technical procedures that are relevant for orthopaedic surgeons in training. Round 2 was performed on a departmental basis; it explored the frequency of procedures, the number of surgeons performing each procedure, the risk and/or discomfort to patients, and the feasibility for simulation-based training to prioritize and eliminate some of the procedures that were determined in round 1. During round 3, the experts eliminated and reprioritized procedures from round 2 to produce a final prioritized list. RESULTS During the first round, 194 procedures were identified. These were reduced to 62 in round 2, and the final list after round 3 consisted of 33 prioritized procedures that are relevant for simulation-based training in orthopaedic surgery. The response rates were 63 of 95 physicians for round 1, 26 of 26 departments for round 2, and 64 of 97 physicians for round 3. The highest prioritized procedures were basic surgical techniques and principles for osteosynthesis, osteosynthesis of proximal femoral fracture, and surgical exposure of the upper and lower extremities. CONCLUSIONS The prioritized list of technical procedures in orthopaedic surgery that are suitable for simulation-based training can aid in the development of a simulation-based curriculum. CLINICAL RELEVANCE This article offers insights into needs assessment and curriculum development of simulation-based training in orthopaedic surgery and traumatology.
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Affiliation(s)
- Amandus Gustafsson
- Copenhagen Academy for Medical Education and Simulation and The Capital Region of Denmark, Copenhagen, Denmark.,Orthopaedic Department, Slagelse Hospital, Slagelse, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital, Hospital Lillebaelt, Kolding, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Denmark
| | | | - Henrik Palm
- Orthopaedic Department, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation and The Capital Region of Denmark, Copenhagen, Denmark.,Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation and The Capital Region of Denmark, Copenhagen, Denmark
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James HK, Chapman AW, Pattison GTR, Griffin DR, Fisher JD. Systematic review of the current status of cadaveric simulation for surgical training. Br J Surg 2019; 106:1726-1734. [PMID: 31573088 PMCID: PMC6900127 DOI: 10.1002/bjs.11325] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/09/2019] [Accepted: 07/04/2019] [Indexed: 12/18/2022]
Abstract
Background There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric simulation in postgraduate surgical training. Methods A PRISMA‐compliant systematic literature review of studies that prospectively evaluated a cadaveric simulation training intervention for surgical trainees was undertaken. All relevant databases and trial registries were searched to January 2019. Methodological rigour was assessed using the widely validated Medical Education Research Quality Index (MERSQI) tool. Results A total of 51 studies were included, involving 2002 surgical trainees across 69 cadaveric training interventions. Of these, 22 assessed the impact of the cadaveric training intervention using only subjective measures, five measured impact by change in learner knowledge, and 23 used objective tools to assess change in learner behaviour after training. Only one study assessed patient outcome and demonstrated transfer of skill from the simulated environment to the workplace. Of the included studies, 67 per cent had weak methodology (MERSQI score less than 10·7). Conclusion There is an abundance of relatively low‐quality evidence showing that cadaveric simulation induces short‐term skill acquisition as measured by objective means. There is currently a lack of evidence of skill retention, and of transfer of skills following training into the live operating theatre.
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Affiliation(s)
- H K James
- Clinical Trials Unit, Warwick Medical School, University Hospitals Coventry and Warwickshire, Coventry, UK.,Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - A W Chapman
- Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - G T R Pattison
- Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - D R Griffin
- Clinical Trials Unit, Warwick Medical School, University Hospitals Coventry and Warwickshire, Coventry, UK.,Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - J D Fisher
- Clinical Trials Unit, Warwick Medical School, University Hospitals Coventry and Warwickshire, Coventry, UK
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Javid P, Aydın A, Mohanna P, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: A systematic review. Microsurgery 2019; 39:655-668. [DOI: 10.1002/micr.30513] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/25/2019] [Accepted: 08/30/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Pernia Javid
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Abdullatif Aydın
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Pari‐Naz Mohanna
- Department of Plastic SurgeryGuy's and St. Thomas' NHS Foundation Trust London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
- Department of UrologyKing's College Hospital NHS Foundation Trust London UK
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Current status of simulation-based training in pediatric surgery: A systematic review. J Pediatr Surg 2019; 54:1884-1893. [PMID: 30573294 DOI: 10.1016/j.jpedsurg.2018.11.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/09/2018] [Accepted: 11/05/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Simulation based training enables pediatric surgical trainees to attain proficiency in surgical skills. This study aims to identify the currently available simulators for pediatric surgery, assess their validation and strength of evidence supporting each model. METHODS Both Medline and EMBASE were searched for English language articles either describing or validating simulation models for pediatric surgery. A level of evidence (LoE) followed by a level of recommendation (LoR) was assigned to each validation study and simulator, based on a modified Oxford Centre for Evidence-Based Medicine classification for educational studies. RESULTS Forty-nine articles were identified describing 44 training models and courses. Of these articles, 44 were validation studies. Face validity was evaluated by 20 studies, 28 for content, 24 demonstrated construct validity and 1 showed predictive validity. Of the validated models, 3 were given an LoR of 2, 21 an LoR of 3 and 12 an LoR of 4. None reached the highest LoR. CONCLUSIONS There are a growing number of simulators specific to pediatric surgery. However, these simulators have limited LoE and LoR in current studies. The lack of NoTSS training is also apparent. We advocate more randomized trials to validate these models, and attempts to determine predictive validity. TYPE OF STUDY Original / systematic review. LEVEL OF EVIDENCE 1.
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Rasmussen RC, Grauslund J, Vergmann AS. Simulation training in vitreoretinal surgery: a systematic review. BMC Ophthalmol 2019; 19:90. [PMID: 30975112 PMCID: PMC6460826 DOI: 10.1186/s12886-019-1098-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to perform a systematic review of the current literature on simulator-based training in vitreoretinal surgery (VRS). We examined the results regarding simulated VRS and provided an overview of how the current results may be employed in VRS training. Lastly, we evaluated the quality of these results. Methods The databases of Pubmed, Embase and Cochrane Library were searched for articles in English involving simulated VRS training. A qualitative analysis was performed, since the studies which met our inclusion criteria did not allow for a quantitative meta-analysis. Results We identified 203 articles of which seven met the inclusion criteria. Of these, six studies investigated simulation with EyeSi® Surgical (VRMagic, Mannheim, Germany). Six studies reported positive performance curves. Four studies showed construct validity. One study attempted to show skill transfer from simulator to vitrectomies performed on cadavers. Methodological quality of the included studies was moderate but lacking in instrument validation. Conclusion Simulator-based training in VRS can assess and possibly assist acquisition of a variety of VRS skills. Further research is needed to support transfer from simulator to operating room. Future studies should strive to follow established validation frameworks and streamline study designs. Electronic supplementary material The online version of this article (10.1186/s12886-019-1098-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rasmus Christian Rasmussen
- Department of Ophthalmology, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000, Odense C, Denmark.
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Winløwsparken 19, DK-5000, Odense C, Denmark
| | - Anna Stage Vergmann
- Department of Ophthalmology, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Winløwsparken 19, DK-5000, Odense C, Denmark
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Vertemati M, Cassin S, Rizzetto F, Vanzulli A, Elli M, Sampogna G, Gallieni M. A Virtual Reality Environment to Visualize Three-Dimensional Patient-Specific Models by a Mobile Head-Mounted Display. Surg Innov 2019; 26:359-370. [PMID: 30632462 DOI: 10.1177/1553350618822860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With the availability of low-cost head-mounted displays (HMDs), virtual reality environments (VREs) are increasingly being used in medicine for teaching and clinical purposes. Our aim was to develop an interactive, user-friendly VRE for tridimensional visualization of patient-specific organs, establishing a workflow to transfer 3-dimensional (3D) models from imaging datasets to our immersive VRE. MATERIALS AND METHODS This original VRE model was built using open-source software and a mobile HMD, Samsung Gear VR. For its validation, we enrolled 33 volunteers: morphologists (n = 11), trainee surgeons (n = 15), and expert surgeons (n = 7). They tried our VRE and then filled in an original 5-point Likert-type scale 6-item questionnaire, considering the following parameters: ease of use, anatomy comprehension compared with 2D radiological imaging, explanation of anatomical variations, explanation of surgical procedures, preoperative planning, and experience of gastrointestinal/neurological disorders. Results in the 3 groups were statistically compared using analysis of variance. RESULTS Using cross-sectional medical imaging, the developed VRE allowed to visualize a 3D patient-specific abdominal scene in 1 hour. Overall, the 6 items were evaluated positively by all groups; only anatomy comprehension was statistically significant different among the 3 groups. CONCLUSIONS Our approach, based on open-source software and mobile hardware, proved to be a valid and well-appreciated system to visualize 3D patient-specific models, paving the way for a potential new tool for teaching and preoperative planning.
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Affiliation(s)
| | | | | | | | - Marco Elli
- 1 Università degli Studi di Milano, Milan, Italy
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A Multi-procedural Virtual Reality Simulator for Orthopaedic Training. VIRTUAL, AUGMENTED AND MIXED REALITY. APPLICATIONS AND CASE STUDIES 2019. [DOI: 10.1007/978-3-030-21565-1_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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