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Chapek M, Otlans PT, Buuck T, Nguyen JT, Sullivan JP, Grawe BM, Nicandri GT, Brady JM. Resident Performance on the Fundamentals of Arthroscopic Surgery Training (FAST) Workstation Does Not Predictably Improve With Postgraduate Year. Arthrosc Sports Med Rehabil 2024; 6:100866. [PMID: 38318395 PMCID: PMC10840096 DOI: 10.1016/j.asmr.2023.100866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] Open
Abstract
Purpose To identify differences in performance on the Fundamentals of Arthroscopic Surgery Training (FAST) workstation between residents across different postgraduate years and training sites. Methods During the 2018-2019 academic year, 102 orthopaedic surgery residents from 4 training sites completed 6 FAST modules. Failure was defined as either completion time exceeding benchmark time or commission of task-specific errors. With the exception of knot tying, each module was completed by participants twice-once with each hand serving as the camera hand. Time to completion (except for knot tying) and errors were recorded for each of the modules. Completion times and failure rates were compared between postgraduate years, seniority groups, and training sites. Results In all modules for which time was recorded, except for the suture-passage module, there was no significant difference in time to completion based on seniority (P < .01 for suture passage and P > .05 for all others). Significant differences in completion time were observed between sites for all modules except for the suture-passage module (P = .957 for suture passage and P < .05 for all others). Site predicted failure by at least 1 measure (time or technical error) for all modules (P < .05) except for number probing and suture passage. Failure rate across training years varied for each module. Conclusions Time to completion and rate of failure did not predictably decrease with level of training. Training site proved to be a significant predictor of performance. Factors such as hand dominance and familiarity with the equipment proved to be important considerations for some modules. Clinical Relevance Objective assessment of arthroscopic skills among orthopaedic trainees is difficult. Using reproducible methodology to assess trainees on specific skills at all postgraduate years and at multiple training sites may provide important information about orthopaedic training.
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Affiliation(s)
- Michael Chapek
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, U.S.A
| | - Peters T. Otlans
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Taylor Buuck
- Department of Orthopedic Surgery, Beaumont Health System, Royal Oak, Michigan, U.S.A
| | - Joseph T. Nguyen
- Epidemiology and Biostatistics Core Facility, Hospital for Special Surgery, New York, New York, U.S.A
| | - Jaron P. Sullivan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Brian M. Grawe
- Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Gregg T. Nicandri
- Department of Orthopaedics, University of Rochester Medical Center, Penfield, New York, U.S.A
| | - Jacqueline M. Brady
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, U.S.A
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Dau L, Almeida PA, Kulcheski AL, Milcent PA, Filho ES. Construct Validity and Experience of Using a Low-cost Arthroscopic Shoulder Surgery Simulator. Rev Bras Ortop 2023; 58:e790-e797. [PMID: 37908521 PMCID: PMC10615612 DOI: 10.1055/s-0043-1771003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/27/2022] [Indexed: 11/02/2023] Open
Abstract
Objective To validate the low-cost model for arthroscopy training and analyze the acceptance and usefulness of the developed simulator in medical teaching and training. Method Ten medical students, ten third-year orthopedic residents, and ten shoulder surgeons performed predetermined tasks on a shoulder simulator twice. The parameters used were time to complete the tasks, number of looks at the hands, GOALS score (Global Operative Assessment of Laparoscopic Skills) and comparison between groups and within groups. An adapted Likert scale was applied addressing the individuals' impressions about the simulator and its applicability. Results In the intergroup comparison, the shoulder surgeons had better scores and times than the other groups. When the tasks were repeated, the group of surgeons had a 59% improvement in time (p < 0.05), as did the group of medical students. In the GOALS score, shoulder surgeons had consistently better scores than the other groups. And when we evaluated the evolution from the first to the second test, the group of surgeons and the group of academics had a statistically significant improvement (p < 0.05). In terms of lookdowns, there was a decrease in all groups. There was consensus that the simulator is useful in training. Conclusion The simulator developed allowed the differentiation between individuals with different levels of training in arthroscopic surgery. It was accepted by 100% of the participants as a useful tool in arthroscopic shoulder surgical training.
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Affiliation(s)
- Leonardo Dau
- Chefe do Grupo de Cirurgia de Ombro e Cotovelo, Hospital Universitário Evangélico Mackenzie (HUEM), Curitiba, PR, Brasil
| | - Paula Adamo Almeida
- Acadêmica do Curso de Medicina da Universidade Federal do Paraná, Curitiba, Paraná, Brasil
| | | | - Paul Andre Milcent
- Mestrando do curso de pós graduação, Universidade Federal do Paraná, Curitiba, Paraná, Brasil
| | - Edmar Stieven Filho
- Professor do Departamento de Cirurgia, Universidade Federal do Paraná, Curitiba, Paraná, Brasil
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Domes C, Coale M, Weber A, Isaac M, Udogwu U, O'Hara NN, Christian M, O'Toole RV, Sciadini MF. Can a Computer-based Force Feedback Hip Fracture Skills Simulator Improve Clinical Task Performance? A Cadaveric Validation Study. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00017. [PMID: 37192148 DOI: 10.5435/jaaosglobal-d-22-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/19/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND This cadaveric study seeks to determine whether skills acquired on the simulator translate to improved performance of the clinical task. We hypothesized that completion of simulator training modules would improve performance of percutaneous hip pinning. METHODS Eighteen right-handed medical students from two academic institutions were randomized: trained (n = 9) and untrained (n = 9). The trained group completed nine simulator-based modules of increasing difficulty, designed to teach techniques of placing wires in an inverted triangle construct in a valgus-impacted femoral neck fracture. The untrained group had a brief simulator introduction but did not complete the modules. Both groups received a hip fracture lecture, an explanation and pictorial reference of an inverted triangle construct, and instruction on using the wire driver. Participants then placed three 3.2 mm guidewires in cadaveric hips in an inverted triangle construct under fluoroscopy. Wire placement was evaluated with CT at 0.5 mm sections. RESULTS The trained group significantly outperformed the untrained group in most parameters (P ≤ 0.05). CONCLUSIONS The results suggest that a force feedback simulation platform with simulated fluoroscopic imaging using an established, increasingly difficult series of motor skills training modules has potential to improve clinical performance and might offer an important adjunct to traditional orthopaedic training.
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Affiliation(s)
- Christopher Domes
- From R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical School, Baltimore, MD
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Swindell HW, deMeireles AJ, Zhong JR, Bixby EC, Saltzman BM, Jobin CM, Levine WN, Trofa DP. Quantifying the Opportunity Cost of Resident Involvement in Academic Orthopedic Shoulder Arthroplasty: A Matched - Pair Analysis. Shoulder Elbow 2023; 15:151-158. [PMID: 37035610 PMCID: PMC10078817 DOI: 10.1177/17585732211065444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
Abstract
Background There is minimal work defining the economic impact of resident participation in shoulder arthroplasty. Thus, this study quantified the opportunity cost of resident participation in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) by determining differences in operative time, relative value units (RVUs)/hour, and RVUs/case. Methods A retrospective analysis of shoulder arthroplasty procedures were identified from the ACS-NSQIP database from 2006 to 2014 using CPT codes. Demographic, comorbidity, preoperative laboratory data and surgical procedure were used to develop matched cohorts. Mean differences in operative time, RVUs/case and RVUs/hour between attending-only (AO) cases and cases with resident involvement (RI) were examined. Cost analysis was performed to identify differences in RVUs generated per hour in dollars/case. Results A total of 1786 AO and 1102 RI cases were identified. With the exception of PGY-3 and PGY-4 cases, RI cases had lower mean operative times compared to AO cases. The cost of RI was highest for PGY-3 ($199.87 per case) and PGY-4 ($9 .2 9) residents with all other postgraduate years providing a cost reduction. Discussion Involvement of residents was associated with shorter operative times leading to a savings of $29.64 per case. Involvement of intermediate-level (PGY-3) residents were associated with increased costs that ultimately decreased as residents became more senior.
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Affiliation(s)
- Hasani W Swindell
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, NY, NY, USA
| | - Jack R Zhong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, NY, NY, USA
| | - Elise C Bixby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, NY, NY, USA
| | - Bryan M Saltzman
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, NY, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, NY, NY, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, NY, NY, USA
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Casey JC, Daniels AH. CORR Synthesis: How Have Film Review and Motion Analysis Been Used to Enhance Orthopaedic Surgical Performance? Clin Orthop Relat Res 2023; 481:564-579. [PMID: 36719752 PMCID: PMC9928675 DOI: 10.1097/corr.0000000000002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Jack C. Casey
- Division of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H. Daniels
- Division of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Liao R, Yang Y, Li W, Li Z, Li X, Xiong W, Lin C, Xiao Y, Tian J. Effective Skill Transfer From Fundamentals of Arthroscopic Surgery Training to Shoulder Arthroscopic Simulator in Novices. Surg Innov 2023; 30:103-108. [PMID: 35608178 DOI: 10.1177/15533506221104379] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate whether novices could improve performance on a shoulder arthroscopic simulator (high-fidelity) through short-term training on a Fundamentals of Arthroscopic Surgery Training (FAST) simulator (low-fidelity). METHODS Twenty-eight novices with no experience in arthroscopy were recruited to perform a pre-test on a shoulder arthroscopic simulator. Then they were randomized into two groups: the experimental group practiced five modules on the FAST simulator three times, and the control group did nothing. The experimental group performed a post-test immediately after FAST simulator practice. Control group rested for 70 minutes after experiencing pre-test before performing post-test. All parameters were recorded by the simulator. RESULTS The experimental group outperformed the control group in terms of total score, procedure time, camera path length, and grasper path length. However, there was no statistical difference in scratching of humerus cartilage or glenoid cartilage. Significant differences were found in the improvement of both groups in total score, procedure time, and camera path length. CONCLUSIONS Arthroscopic skills gained after short-term training on FAST simulator could be transferred to the shoulder arthroscopic simulator. This research provides important evidence of the benefits of FAST simulator in shoulder arthroscopy training program.
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Affiliation(s)
- Rongdong Liao
- Department of Orthopaedics, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
| | - Yipei Yang
- Department of Orthopaedics, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
| | - Wei Li
- Department of Orthopaedics, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
| | - Ziyue Li
- Department of Ultrasound, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
| | - Xian Li
- Department of Orthopaedics, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
| | - Weibin Xiong
- Clinical Skills Training Centre, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
| | - Chuyang Lin
- Clinical Skills Training Centre, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
| | - Yao Xiao
- Clinical Skills Training Centre, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
| | - Jing Tian
- Clinical Skills Training Centre, Zhujiang Hospital, 70570Southern Medical University, Guangzhou, China
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Lee S, Shetty AS, Cavuoto L. Modeling of Learning Processes Using Continuous-Time Markov Chain for Virtual-Reality-Based Surgical Training in Laparoscopic Surgery. IEEE TRANSACTIONS ON LEARNING TECHNOLOGIES 2023; 17:462-473. [PMID: 38617582 PMCID: PMC11013959 DOI: 10.1109/tlt.2023.3236899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Recent usage of Virtual Reality (VR) technology in surgical training has emerged because of its cost-effectiveness, time savings, and cognition-based feedback generation. However, the quantitative evaluation of its effectiveness in training is still not studied thoroughly. This paper demonstrates the effectiveness of a VR-based surgical training simulator in laparoscopic surgery and investigates how stochastic modeling represented as Continuous-time Markov-chain (CTMC) can be used to explicit the training status of the surgeon. By comparing the training in real environments and in VR-based training simulators, the authors also explore the validity of the VR simulator in laparoscopic surgery. The study further aids in establishing learning models of surgeons, supporting continuous evaluation of training processes for the derivation of real-time feedback by CTMC-based modeling.
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Affiliation(s)
- Seunghan Lee
- Industrial and Systems Engineering Department at Mississippi State University
| | | | - Lora Cavuoto
- Industrial and Systems Engineering at the University at Buffalo, Buffalo, NY, USA
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Li W, Meng X, Zhang KJ, Yang Z, Feng Z, Tong K, Tian J. Meditation Using a Mobile App Improves Surgery Trainee Performance: a simulation-based randomized controlled trial. Arthroscopy 2022; 39:1262-1270. [PMID: 36191734 DOI: 10.1016/j.arthro.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To primarily investigate: (1) whether a 10 min instant meditation practice using mobile app could enhance arthroscopy performance and (2) whether a 10-day app-based meditation could reduce short-term arthroscopic skills deterioration. METHODS Orthopedic residents with no previous experience in arthroscopy and meditation were randomly assigned to Groups A, B, and C. After initial standard competency-based arthroscopy training on the simulator on Day 1, a pretest was performed via simulator by all participants to assess their initial level of performance, then Groups A and B were required to practice app-based mindfulness meditation 10 min/day for 10 consecutive days, while Group C did nothing. On Day 11, all participants came back to perform a posttest. Prior to the posttest, the participants in Group A practiced app-based meditation (10 min) , whereas Groups B and C had no intervention. RESULTS 43 participants were included and reached similar level of performance after initial training phase in Day1. In Day11, participants in Group A had statistically better instant arthroscopy performance than Group B, with higher total score (Mean Difference, 3.57; P<.001), less completion time (MD, -42.89s; P=.001), shorter camera (MD, -23.38cm; P<.001) and grasper (MD, -15.23cm; P=.002) path length and less cartilage injury (MD, -1.07%; P=.012). Participants in Group B had less skills deterioration than Group C, with better total score (MD, -5.42; P<.001), less completion time (MD, 51.96s; P=.002), camera path length (MD, 28.41cm; P=.007) and cartilage injury (MD, 1.19%; P=.038). CONCLUSION Meditation training using mobile app enhanced instant simulation-based arthroscopy performance and reduced short-term skills deterioration of orthopedic residents with no arthroscopy hands-on experience. CLINICAL RELEVANCE Meditation using mobile app for clinicians and educators should be incorporated into simulation-based arthroscopy curriculums and perhaps clinical settings to improve arthroscopy performance and mental health of orthopedic residents without any prior arthroscopy experience.
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Affiliation(s)
- Wei Li
- Departments of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangqing Meng
- Department of Orthopedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Kai-Jun Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhouwen Yang
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhuoxi Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Kuang Tong
- Teaching Affairs Office, Southern Medical University, Guangzhou, China.
| | - Jing Tian
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Cai B, Duan S, Yi J, Huang W, Bay BH, Li C, Chen C. Training surgical skills on hip arthroscopy by simulation: a survey on surgeon's perspectives. Int J Comput Assist Radiol Surg 2022; 17:1813-1821. [PMID: 35831550 PMCID: PMC9468038 DOI: 10.1007/s11548-022-02708-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/21/2022] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to investigate the importance of general and specific surgical skills for hip arthroscopy from the perspective of surgeons in China. Concurrently, we intend to identify the preferred type of simulation that would facilitate competency of surgical trainees in performing arthroscopy and reinforce their preparation for carrying out the actual surgical procedure. Methods An online survey comprising 42 questions was developed by experts in hip arthroscopy and sent to 3 online communities whose members are arthroscopic surgeons in China. The responses collected were based on a 5-point Likert scale, with an open-ended comment section. Data were analyzed using one-way AVOVA and post hoc Tukey’s test. Results A total of 159 valid responses from 66 junior specialist surgeons, 68 consultant surgeons, and 25 senior consultant surgeons (from 130 institutions in 27 out of 34 provincial administrative districts in China) were collected. Cognitive ability was identified as the overall most important attribute for hip arthroscopic trainees to possess, while skills relevant to the treatment of femoroacetabular impingement (FAI) were considered as the most important specific skills by the surgeons surveyed. In addition, simulation using cadaveric specimens was considered the most favorable method for surgeons to practice their surgical skills. Conclusion In designing a training program for hip arthroscopy, it is essential to incorporate features that evaluate cognitive skills. It would be helpful for trainees to specifically practice skills that are often used in the treatment of some very common diseases of the hip joint, such as FAI. Using high-fidelity physical models for simulation to train skills of hip arthroscopy could be an ideal alternative and effective way to overcome problems arising from the lack of accessibility to cadaveric specimens. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-022-02708-x.
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Affiliation(s)
- Bohong Cai
- 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
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Boon Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chunbao Li
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
| | - Cheng Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Failure of Orthopaedic Residents to Voluntarily Participate in a Laboratory Skills Training. J Am Acad Orthop Surg 2022; 30:161-167. [PMID: 34910714 DOI: 10.5435/jaaos-d-21-00680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Arthroscopy simulation is increasingly used in orthopaedic residency training. The implementation of a curriculum to accommodate these new training tools is a point of interest. We assessed the use of a high-fidelity arthroscopy simulator in a strictly voluntary curriculum to gauge resident interest and educational return. METHODS Fifty-eight months of simulator use data were collected from a single institution to analyze trends in resident use. Comparable data from two additional residency programs were analyzed as well, for comparison. Orthopaedic residents were surveyed to gauge interest in continued simulation training. RESULTS Average annual simulator use at the study institution was 27.7 hours (standard deviation = 26.8 hours). Orthopaedic residents spent an average of 1.7 hours practicing on the simulation trainer during the observation period. A total of 21% of residents met or exceeded a minimum of 3 hours of simulation time required for skill improvement defined by literature. Most (86%) of the residents agreed that the simulator in use should become a mandated component of a junior resident training. CONCLUSION Although surgical simulation has a role in orthopaedic training, voluntary simulator use is sporadic, resulting in many residents not receiving the full educational benefits of such training. Implementation of a mandated simulation training curriculum is desired by residents and could improve the educational return of surgical simulators in residency training.
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Tronchot A, Berthelemy J, Thomazeau H, Huaulmé A, Walbron P, Sirveaux F, Jannin P. Validation of virtual reality arthroscopy simulator relevance in characterising experienced surgeons. Orthop Traumatol Surg Res 2021; 107:103079. [PMID: 34597826 DOI: 10.1016/j.otsr.2021.103079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Virtual reality (VR) simulation is particularly suitable for learning arthroscopy skills. Despite significant research, one drawback often outlined is the difficulty in distinguishing performance levels (Construct Validity) in experienced surgeons. Therefore, it seems adequate to search new methods of performance measurements using probe trajectories instead of commonly used metrics. HYPOTHESIS It was hypothesized that a larger experience in surgical shoulder arthroscopy would be correlated with better performance on a VR shoulder arthroscopy simulator and that experienced operators would share similar probe trajectories. MATERIALS & METHODS After answering to standardized questionnaires, 104 trajectories from 52 surgeons divided into 2 cohorts (26 intermediates and 26 experts) were recorded on a shoulder arthroscopy simulator. The procedure analysed was the "loose body removal" in a right shoulder joint. 10 metrics were computed on the trajectories including procedure duration, overall path length, economy of motion and smoothness. Additionally, Dynamic Time Warping (DTW) was computed on the trajectories for unsupervised hierarchical clustering of the surgeons. RESULTS Experts were significantly faster (Median 70.9s Interquartile range [56.4-86.3] vs. 116.1s [82.8-154.2], p<0.01), more fluid (4.6.105mm.s-3 [3.1.105-7.2.105] vs. 1.5.106mm.s-3 [2.6.106-3.5.106], p=0.05), and economical in their motion (19.3mm2 [9.1-25.9] vs. 33.8mm2 [14.8-50.5], p<0.01), but there was no significant difference in performance for path length (671.4mm [503.8-846.1] vs 694.6mm [467.0-1090.1], p=0.62). The DTW clustering differentiates two expertise related groups of trajectories with performance similarities, respectively including 48 expert trajectories for the first group and 52 intermediates and 4 expert trajectories for the second group (Sensitivity of 92%, Specificity of 100%). Hierarchical clustering with DTW significantly identified expert operators from intermediate operators and found trajectory similarities among 24/26 experts. CONCLUSION This study demonstrated the Construct Validity of the VR shoulder arthroscopy simulator within groups of experienced surgeons. With new types of metrics simply based on the simulator's raw trajectories, it was possible to significantly distinguish levels of expertise. We demonstrated that clustering analysis with Dynamic Time Warping was able to reliably discriminate between expert operators and intermediate operators. CLINICAL RELEVANCE The results have implications for the future of arthroscopic surgical training or post-graduate accreditation programs using virtual reality simulation. LEVEL OF EVIDENCE III; prospective comparative study.
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Affiliation(s)
- Alexandre Tronchot
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; Orthopaedics and Trauma Department, Rennes University Hospital, 2 rue Henri Le Guilloux, 35000 Rennes, France.
| | | | - Hervé Thomazeau
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; Orthopaedics and Trauma Department, Rennes University Hospital, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Arnaud Huaulmé
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Paul Walbron
- Orthopaedics Department, Nancy University Hospital, Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000 Nancy, France
| | - François Sirveaux
- Orthopaedics Department, Nancy University Hospital, Centre Chirurgical Emile Gallé, 49 rue Hermite, 54000 Nancy, France
| | - Pierre Jannin
- University Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
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James HK, Chapman AW, Pattison GTR, Fisher JD, Griffin DR. Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training: A Systematic Review. JBJS Rev 2021; 8:e1900167. [PMID: 33006464 PMCID: PMC7360100 DOI: 10.2106/jbjs.rvw.19.00167] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Robust assessment of skills acquisition and surgical performance during training is vital to ensuring operative competence among orthopaedic surgeons. A move to competency-based surgical training requires the use of tools that can assess surgical skills objectively and systematically. The aim of this systematic review was to describe the evidence for the utility of assessment tools used in evaluating operative performance in trauma and orthopaedic surgical training. METHODS We performed a comprehensive literature search of MEDLINE, Embase, and Google Scholar databases to June 2019. From eligible studies we abstracted data on study aim, assessment format (live theater or simulated setting), skills assessed, and tools or metrics used to assess surgical performance. The strengths, limitations, and psychometric properties of the assessment tools are reported on the basis of previously defined utility criteria. RESULTS One hundred and five studies published between 1990 and 2019 were included. Forty-two studies involved open orthopaedic surgical procedures, and 63 involved arthroscopy. The majority (85%) were used in the simulated environment. There was wide variation in the type of assessment tools in used, the strengths and weaknesses of which are assessor and setting-dependent. CONCLUSIONS Current technical skills-assessment tools in trauma and orthopaedic surgery are largely procedure-specific and limited to research use in the simulated environment. An objective technical skills-assessment tool that is suitable for use in the live operative theater requires development and validation, to ensure proper competency-based assessment of surgical performance and readiness for unsupervised clinical practice. CLINICAL RELEVANCE Trainers and trainees can gain further insight into the technical skills assessment tools that they use in practice through the utility evidence provided.
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Affiliation(s)
- Hannah K James
- 1Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom 2Department of Trauma & Orthopedic Surgery, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
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Bishop ME, Ode GE, Hurwit DJ, Zmugg S, Rauck RC, Nguyen JT, Ranawat AS. The Arthroscopic Surgery Skill Evaluation Tool Global Rating Scale is a Valid and Reliable Adjunct Measure of Performance on a Virtual Reality Simulator for Hip Arthroscopy. Arthroscopy 2021; 37:1856-1866. [PMID: 33539979 DOI: 10.1016/j.arthro.2021.01.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to further evaluate the construct validity and interobserver reliability of a hip arthroscopy virtual simulator using the Arthroscopic Surgery Skill Evaluation Tool (ASSET) global rating scale. METHODS Thirty participants (23 male/7 female) completed a diagnostic arthroscopy and a loose body retrieval simulation on the VirtaMed Arthros Hip Simulator (Zurich, Switzerland) twice at a minimum of 1 week apart. Subjects consisted of 12 novices (medical students, postgraduate year [PGY] 1-2), 5 intermediate trainees (PGY3-4), 9 senior trainees (PGY5 and fellows), and 4 attending faculty. Simulator metrics were recorded and then compiled to generate a total simulator score (TSS). The loose body retrieval was graded using the ASSET scoring tool. Inter-rater and intrarater reliability for the ASSET for 2 blinded raters and construct validity of the ASSET and the TSS were calculated. Correlation between the TSS, ASSET and individual simulator metrics was determined. RESULTS Prior simulation experience (P ≤ 0.01) correlated with higher TSS and higher ASSET, while video game experience correlated with higher TSS on the diagnostic module only (P = 0.004). There was a significant difference in ASSET score among all experience groups (P < 0.04). Novices had the lowest mean ASSET whereas experts had the highest mean ASSET with a difference of 17.4 points. Overall performance on the surgical module significantly correlated with the ASSET score (r = 0.444, P = 0.016). There was a significant positive correlation among higher ASSET and number of loose bodies retrieved, operation time, camera path and grasper path length, and percentage of cartilage injury. ASSET demonstrated excellent intrarater reliability and showed substantial or better inter-reliability in 8 of 9 domains. CONCLUSION The VirtaMed hip arthroscopy simulator demonstrated good construct validity and excellent reliability for simulator-based metrics and ASSET score. Use of both simulator metrics and ASSET offers a more comprehensive performance assessment on hip arthroscopy simulation than either measure alone. CLINICAL RELEVANCE As virtual reality simulation for arthroscopy becomes more commonplace in orthopaedic training, evaluation of the most effective objective and subjective measures of performance is necessary to optimize simulation training.
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Affiliation(s)
| | - Gabriella E Ode
- Department of Orthopaedics, Prisma Health-Upstate, Greenville, South Carolina, U.S.A..
| | - Daniel J Hurwit
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, U.S.A
| | - Stephan Zmugg
- Department of Orthopaedic Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, U.S.A
| | - Ryan C Rauck
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joseph T Nguyen
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, U.S.A
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Hauschild J, Rivera JC, Johnson AE, Burns TC, Roach CJ. Shoulder Arthroscopy Simulator Training Improves Surgical Procedure Performance: A Controlled Laboratory Study. Orthop J Sports Med 2021; 9:23259671211003873. [PMID: 33997080 PMCID: PMC8113660 DOI: 10.1177/23259671211003873] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures. Purpose/Hypothesis: To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair. It was hypothesized that both DL and VR simulation methods would improve procedure performance; however, VR simulation would be more effective based on the validated Arthroscopic Surgery Skill Evaluation Tool (ASSET) Global Rating Scale. Study Design: Controlled laboratory study. Methods: Enrolled in the study were 38 orthopaedic residents at a single institution, postgraduate years (PGYs) 1 to 5. Each resident completed a pretest shoulder stabilization procedure on a cadaveric model and was then randomized into 1 of 2 groups: VR or DL simulation. Participants then underwent a 4-week arthroscopy simulation program and completed a posttest. Sports medicine–trained orthopaedic surgeons graded the participants on completeness of the surgical repair at the time of the procedure, and a single, blinded orthopaedic surgeon, using the ASSET Global Rating Scale, graded participants’ arthroscopy skills. The procedure step and ASSET grades were compared between simulator groups and between PGYs using paired t tests. Results: There was no significant difference between the groups in pretest performance in either the procedural steps or ASSET scores. Overall procedural step scores improved after combining both types of simulator training (P = .0424) but not in the individual simulation groups. The ASSET scores improved across both DL (P = .0045) and VR (P = .0003), with no significant difference between the groups. Conclusion: A 4-week simulation program can improve arthroscopic skills and performance during a specific surgical procedure. This study provides additional evidence regarding the benefits of simulator training in orthopaedic surgery for both novice and experienced arthroscopic surgeons. There was no statistically significant difference between the VR and DL models, which disproved the authors’ hypothesis that the VR simulator would be the more effective simulation tool. Clinical Relevance: There may be a role for simulator training in the teaching of arthroscopic skills and learning of specific surgical procedures.
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Berthold DP, Imhoff AB, Mazzocca AD. Virtual Reality in der Gelenkchirurgie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-020-00426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lakhani S, Selim OA, Saeed MZ. Arthroscopic Simulation: The Future of Surgical Training: A Systematic Review. JBJS Rev 2021; 9:01874474-202103000-00006. [PMID: 33750750 DOI: 10.2106/jbjs.rvw.20.00076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Arthroscopic simulation has rapidly evolved recently with the introduction of higher-fidelity simulation models, such as virtual reality simulators, which provide trainees an environment to practice skills without causing undue harm to patients. Simulation training also offers a uniform approach to learn surgical skills with immediate feedback. The aim of this article is to review the recent research investigating the use of arthroscopy simulators in training and the teaching of surgical skills. METHODS A systematic review of the Embase, MEDLINE, and Cochrane Library databases for English-language articles published before December 2019 was conducted. The search terms included arthroscopy or arthroscopic in combination with simulation or simulator. RESULTS We identified a total of 44 relevant studies involving benchtop or virtually simulated ankle, knee, shoulder, and hip arthroscopy environments. The majority of these studies demonstrated construct and transfer validity; considerably fewer studies demonstrated content and face validity. CONCLUSIONS Our review indicates that there is a considerable evidence base regarding the use of arthroscopy simulators for training purposes. Further work should focus on the development of a more uniform simulator training course that can be compared with current intraoperative training in large-scale trials with long-term follow-up at tertiary centers.
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Affiliation(s)
- Saad Lakhani
- Division of Surgical & Interventional Sciences, University College London, London, United Kingdom
| | - Omar A Selim
- Division of Surgical & Interventional Sciences, University College London, London, United Kingdom
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Erquicia J, Gil González S, Barrera Sancho A, Hernández Fernández G, Pelfort López X. Impact of cadaveric practices on arthroscopic knee training for Orthopaedic Surgery and Traumatology residents. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mason EM, Deal MJ, Richey BP, Baker A, Zeini IM, Service BC, Osbahr DC. Innate Arthroscopic & Laparoscopic Surgical Skills: A Systematic Review of Predictive Performance Indicators Within Novice Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2021; 78:178-200. [PMID: 32591323 DOI: 10.1016/j.jsurg.2020.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To query the literature for predictive factors for performance on arthroscopic and laparoscopic surgical simulators in novice surgical trainees. These predictive factors may prove a valuable tool in identifying certain innate potential to becoming a future skilled surgeon that could benefit both surgical residency candidates and program directors alike, while also improving patient care. DESIGN Systematic Review. RESULTS The initial searches yielded 249 articles. After screening titles/abstracts and implementing inclusion and exclusion criteria, 36 studies were included in the final systematic review. CONCLUSIONS Current literature suggests that video game experience/frequency, psychomotor and visuospatial aptitude, and perceptual ability are among the most promising predictive indicators of baseline simulator performance. Study limitations include utilization of different standards for characterizing predictive factors. Future studies should aim to utilize standard guidelines for accurate quantification of innate predictive factors. Future research should also focus on utilizing standardized simulator platforms and aptitude tests to allow for more accurate cross-study comparisons and meta-analyses with larger sample sizes.
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Affiliation(s)
- Eric M Mason
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Bradley P Richey
- University of Central Florida College of Medicine, Orlando, Florida
| | - Alexandra Baker
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Benjamin C Service
- Sports Medicine Division, Orlando Health Orthopedic Institute, Orlando, Florida
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Sepehri A, von Roth P, Stoffel K, Acklin Y, Oussedik S, Wijburg B, Wada A, Cunningham M, Masri BA. Surgical Skills Training Using Simulation for Basic and Complex Hip and Knee Arthroplasty. Orthop Clin North Am 2021; 52:1-13. [PMID: 33222980 DOI: 10.1016/j.ocl.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Skills training is important in an arthroplasty curriculum and can focus either on "part tasks" or on full procedures. The most commonly used simulations in orthopedics including arthroplasty are anatomic specimens, dry bone models, and virtual or other technology-enhanced systems. A course curriculum planning committee must identify the gaps to address, define what learners need to be able to do, and select the most appropriate simulation modality and assessment for delivery. Each simulation must have a clear structure with learning objectives, steps, and take-home messages. Feedback from learners and faculty must be integrated to improve processes and models for future learning.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Orthopaedics, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | | | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Yves Acklin
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
| | - Sam Oussedik
- University College Hospital London, 235 Euston Road, Bloomsbury, London NW1 2BU, UK
| | - Bas Wijburg
- AO Recon, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Arisa Wada
- Education, AO Recon, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Michael Cunningham
- Curriculum Development, AO Foundation - AO Education Institute, Stettbachstrasse 6, Dübendorf 8600, Switzerland
| | - Bassam A Masri
- Department of Orthopaedics, Complex Joint Reconstruction Clinic, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 3rd Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
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Erquicia JI, Gil González S, Barrera Sancho A, Hernández Fernández G, Pelfort López X. Impact of cadaveric practices on arthroscopic knee training for Orthopaedic Surgery and Traumatology residents. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:41-46. [PMID: 33229300 DOI: 10.1016/j.recot.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/25/2020] [Accepted: 07/15/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There currently is a considerable variability in the content of training programs and courses for orthopaedic surgeons in training. Besides this, there is still no consensus regarding which is the most effective methodology for improving learning of the technique or for its qualitative evaluation. A study was carried out to assess the influence of carrying out a cadaveric practical course on the acquisition of arthroscopic technical skills in fifth-year residents. MATERIAL AND METHODS A knee arthroscopy cadaveric course was performed in which 48 students participated. Different technical aspects during a knee arthroscopy, as well as the residents skill and the execution time were evaluated before and after the course using a specific questionnaire. RESULTS There was a significant statistic improvement between the initial and final evaluation, increasing from 11,7 till 17,1 (maximum 20) points. Also, a significant improvement in all the parameters analysed was observed; the identification of anatomic structures (p = 0.001), the palpation of specific structures (p = 0.032), and the time necessary for the arthroscopic knee check (p = 0.015). CONCLUSIONS A knee arthroscopy cadaveric course improves significantly the technical skills of surgeons in training.
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Affiliation(s)
- J I Erquicia
- Hospital Universitari Quirón-Dexeus, ICATME-EQUILAE, Barcelona, España; Departamento de Cirugía Ortopédica y Traumatología, Consorci Sanitari de l'Anoia - Hospital d'Igualada, Igualada, Barcelona, España
| | - S Gil González
- Departamento de Cirugía Ortopédica y Traumatología, Consorci Sanitari de l'Anoia - Hospital d'Igualada, Igualada, Barcelona, España.
| | - A Barrera Sancho
- Departamento de Cirugía Ortopédica y Traumatología, Consorci Sanitari de l'Anoia - Hospital d'Igualada, Igualada, Barcelona, España
| | - G Hernández Fernández
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - X Pelfort López
- Departamento de Cirugía Ortopédica y Traumatología, Consorci Sanitari Parc Taulí, Sabadell, España
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Richey BP, Deal MJ, Baker A, Mason EM, Zeini IM, Osbahr DC, Service BC. Predictors of Performance on the Arthrobox Arthroscopy Simulator for Medical Students. Arthrosc Sports Med Rehabil 2020; 2:e829-e837. [PMID: 33376998 PMCID: PMC7754603 DOI: 10.1016/j.asmr.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/22/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose The purpose of this study was to analyze the effects of past participation in athletics, the playing of musical instruments and video games and other variables on medical students’ performance on an arthroscopic simulator task as well as other assessments of visuospatial ability. Methods We assessed 50 medical students by using previously validated tests of manual dexterity and spatial reasoning as well as performance on an arthroscopic surgical simulator. Inclusion criteria were to be 18 years of age or older and to be a student studying in the M.D. program at a single public state university. Exclusion criteria were previous use of an arthroscopic surgery training device or active participation in an actual arthroscopic surgery, defined as participating as a surgeon, resident trainee, physician’s assistant, or other similarly credentialed professional. Students were also assessed by the use of a high-fidelity ultrasound simulator as a marker of visuospatial capacity. Students were then surveyed about lifestyle characteristics and personal attributes hypothesized to predict surgical skill, such as playing sports, instruments or video games. Results A total of 49 participants were included in this study. High levels of athletic experience were significantly associated with improved performance on the arthroscopic surgical simulator (P = .008). Participants with higher levels of athletic experience were more likely to achieve competence on the arthroscopic surgical simulator (P = .006). Scores on the arthroscopic simulator task were significantly correlated with both ultrasound simulator shape-identification task scores and masked mirror-tracing task scores, as independent measures of visuospatial ability (P = .015 and P = .013, respectively). Conclusions This study provides evidence of a statistically significant correlation between increased experience in athletics and single-use test performance on an arthroscopic surgical simulator. Subjects who reported higher levels of experience in athletics were significantly more likely to achieve competence in the arthroscopic surgical simulator task. Finally, statistically significant correlations were found between subjects’ performance scores on tasks assessed by the surgical simulator, masked mirror-trace assessment and ultrasound simulator. Clinical Relevance Simulator-based training and education allow for the development of arthroscopic skills prior to operating on a live patient in a clinical situation. This is an area of great interest in orthopaedic education. Our study evaluates parameters in a trainee that may relate to a higher performance level in technical skills on an arthroscopic surgical simulator.
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Affiliation(s)
- Bradley P. Richey
- University of Central Florida, College of Medicine, Orlando, Florida, U.S.A
| | | | - Alexandra Baker
- University of Central Florida, College of Medicine, Orlando, Florida, U.S.A
| | - Eric M. Mason
- University of Central Florida, College of Medicine, Orlando, Florida, U.S.A
| | - Ibrahim Mamdouh Zeini
- Orlando Health Orthopedics and Sports Medicine, Orlando, Florida, U.S.A
- Address correspondence to Ibrahim Mamdouh Zeini, Ph.D. P.M.P., S.A., C.C.R.P., Sports Medicine Division, Orlando Health, 22 Lake Beauty Drive, MP 141, Orlando, Florida 32806, U.S.A.
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Foong WS, Teo HLT, Wang DHB, Loh SYJ. Challenges and adaptations in training during pandemic COVID-19: observations by an orthopedic resident in Singapore. Acta Orthop 2020; 91:562-566. [PMID: 32619379 PMCID: PMC8023881 DOI: 10.1080/17453674.2020.1786641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Wei-Sheng Foong
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore,Correspondence:
| | - H L Terry Teo
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - D H Bryan Wang
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - S Y James Loh
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
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Upadhyaya GK, Jain VK, Iyengar KP, Patralekh MK, Vaish A. Impact of COVID-19 on post-graduate orthopaedic training in Delhi-NCR. J Clin Orthop Trauma 2020; 11:S687-S695. [PMID: 32837103 PMCID: PMC7381906 DOI: 10.1016/j.jcot.2020.07.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE OF THE STUDY The Coronavirus disease 2019 (COVID-19) pandemic has had profound effects on healthcare system including medical training and education in India. The study was aimed to evaluate the impact of COVID-19 on post-graduate teaching and learning amongst candidates pursuing higher qualification in orthopaedics, in the Delhi-National Capital Region in India. DESIGN An online cross-sectional survey of 29 questions was circulated amongst post-graduate students pursuing higher orthopaedics degree to evaluate (i) Impact on PG teaching (ii) Impact on surgical training (iii) Impact on Dissertation (iv) Future implications on PG training programme (v) Mental wellbeing. RESULTS 138 (77.5) PG trainees contributed in the survey, and 65.1% of them stated that no clinical classes are being held presently. The majority (94%) confirmed that COVID-19 has affected their surgical and clinical training. A large number (71.6%) had problems in completing their dissertations and 96% had concerns about mental health. CONCLUSION COVID-19 pandemic has severely disrupted the education and training of the Orthopaedic PG students, in Delhi-NCR region and perhaps elsewhere similarly too. The Government and Teaching organisations should take serious consideration of the plights of PGs and devise satisfactory mechanisms to overcome their problems and provide reasonable solutions also.
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Affiliation(s)
- Gaurav Kumar Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Rae Bareli, UP, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | | | - Mohit Kumar Patralekh
- Central Institute of Orthopaedics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Abhishek Vaish
- Department of Orthopedics, Indraprastha Apollo Hospitals, New Delhi, India
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Kogan M, Klein SE, Hannon CP, Nolte MT. Orthopaedic Education During the COVID-19 Pandemic. J Am Acad Orthop Surg 2020; 28:e456-e464. [PMID: 32282439 PMCID: PMC7195844 DOI: 10.5435/jaaos-d-20-00292] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 02/01/2023] Open
Abstract
The COVID-19 global pandemic presents a challenge to orthopaedic education. Around the world, including in the United States, elective surgeries are being deferred and orthopaedic residents and fellows are being asked to make drastic changes to their daily routines. In the midst of these changes are unique opportunities for resident/fellow growth and development. Educational tools in the form of web-based learning, surgical simulators, and basic competency tests may serve an important role. Challenges are inevitable, but appropriate preparation may help programs ensure continued resident growth, development, and well-being while maintaining high-quality patient care.
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Affiliation(s)
- Monica Kogan
- From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Dr. Kogan, Dr. Hannon, and Dr. Nolte), and the Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Dr. Klein)
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Virtual reality simulator improves the acquisition of basic arthroscopy skills in first-year orthopedic surgery residents. Orthop Traumatol Surg Res 2020; 106:717-724. [PMID: 32284277 DOI: 10.1016/j.otsr.2020.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/02/2020] [Accepted: 03/10/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Arthroscopy training using a virtual reality (VR) simulator is said to improve the training of orthopedic surgery residents, although it has never been evaluated in a large representative population of first-year residents. HYPOTHESIS We hypothesized that first-year residents who train on a VR simulator would improve their basic arthroscopy skills more than residents who use other training methods. The primary aim was to compare various arthroscopy-learning techniques after 6 months of training. POPULATION AND METHODS The study population consisted of 107 first-year residents who were tested twice on a VR arthroscopy simulator (December 2017 and June 2018). The residents were divided into three groups: no specific arthroscopy training (A), non-specific and one-off arthroscopy training (B), 6 months of VR arthroscopy simulator training (C). During the testing, they had to perform the Periscoping exercise (orientation of angled scope) and the Catch the Stars Glenohumeral exercise (extraction of loose bodies). The parameters analyzed were time (s), camera alignment relative to horizontal (%), camera path length (cm) and grasper path length (cm). RESULTS After 6 months, there was a significant difference between groups during the Periscoping exercise in the time (A: 137.8 s; B: 126.7 s; C: 92.2 s) (p<0.0001), camera alignment (A: 93%; B: 98%; C: 97%) (p=0.0028), camera path length (A: 116.9cm; B: 112.5cm; C: 67.3cm) (p<0.0001) and during the Catch the Stars Glenohumeral exercise in the time (A: 112.2 s; B: 103 s; C: 61.4 s) (p<0.0001), camera path length (A: 46.3cm; B: 40.9cm; C: 32.9cm) (p<0.0153) and grasper path length (A: 146.4cm; B: 142.2cm; C: 95.8cm) (p<0.0001). DISCUSSION The residents who participated in the VR arthroscopy simulator training program for 6 months had better results when performing practical exercises and standard arthroscopy tasks than those who did not receive any training or only received only one-off training. Their final performance indicated technical mastery that the other residents had not achieved. LEVEL OF EVIDENCE II, Prospective, comparative, non-randomized study.
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Ambrosio L, Vadalà G, Russo F, Papalia R, Denaro V. The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives. J Exp Orthop 2020; 7:35. [PMID: 32458150 PMCID: PMC7250587 DOI: 10.1186/s40634-020-00255-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19+ patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice. In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.
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Affiliation(s)
- Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Weber A, Domes C, Christian M, Coale M, Griffith C, O'Hara NN, Henn RF, O'Toole RV, Sciadini MF. Effect of Training Modules on Hip Fracture Surgical Skills Simulation Performance: Early Validation of the AAOS/OTA Simulator. J Bone Joint Surg Am 2019; 101:2051-2060. [PMID: 31764368 DOI: 10.2106/jbjs.19.00505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A preliminary validation study on a computer-based force-feedback simulation platform demonstrated the ability of the simulator to distinguish between novice and experienced users during a simulated hip-pinning procedure. The purpose of the present study was to further investigate whether the simulator and associated training modules are effective for improving user performance during simulated percutaneous hip-pinning procedures. METHODS With institutional review board approval, 24 medical students at our institution were randomized to "Trained" and "Untrained" groups. After a basic introduction, the Untrained group placed 3 guidewires in a valgus-impacted femoral neck fracture with use of the simulator. The Trained group completed 9 simulator-based training modules before performing the same task. Measured outcomes included an overall performance score and the distance from the pin to various ideals on the femoral neck, femoral head articular surface, and lateral cortex. Performance parameters were compared between groups with the Mann-Whitney U test. RESULTS The Trained group achieved a significantly higher overall score (median, 29) compared with the Untrained group (median, 6) (p < 0.01), outperformed the Untrained group in 4 specific performance metrics, and trended toward improvement over the Untrained group in 4 pin placement measures (p < 0.2). CONCLUSIONS Completion of novel training modules for percutaneous hip pinning on this fluoroscopic surgery simulator improves skill performance on simulator-based objective measurements and a simulated orthopaedic procedure compared with non-simulator-trained surgically inexperienced users. Improvement in the overall score and on 4 of 13 specific performance parameters implies that the training modules more effectively teach only certain motor and 3-dimensional spatial skills. CLINICAL RELEVANCE A valid platform such as the one described here has the potential to improve surgical education in orthopaedic trauma.
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Affiliation(s)
- Annie Weber
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Christopher Domes
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Matthew Christian
- Institute for Foot and Ankle Reconstruction at Mercy, Mercy Medical Center, Baltimore, Maryland
| | - Max Coale
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert V O'Toole
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Marcus F Sciadini
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Cagiltay NE, Ozcelik E, Isikay I, Hanalioglu S, Suslu AE, Yucel T, Berker M. The Effect of Training, Used-Hand, and Experience on Endoscopic Surgery Skills in an Educational Computer-Based Simulation Environment (ECE) for Endoneurosurgery Training. Surg Innov 2019; 26:725-737. [PMID: 31370743 DOI: 10.1177/1553350619861563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Today, virtual simulation environments create alternative hands-on practice opportunities for surgical training. In order to increase the potential benefits of such environments, it is critical to understand the factors that influence them. This study was conducted to determine the effects of training, used-hand, and experience, as well as the interactions between these variables, on endoscopic surgery skills in an educational computer-based surgical simulation environment. A 2-hour computer-based endoneurosurgery simulation training module was developed for this study. Thirty-one novice- and intermediate-level resident surgeons from the departments of neurosurgery and ear, nose, and throat participated in this experimental study. The results suggest that a 2-hour training during a 2-month period through computer-based simulation environment improves the surgical skills of the residents in both-hand tasks, which is necessary for endoscopic surgical procedures but not in dominant hand tasks. Based on the results of this study, it can be concluded that computer-based simulation environments potentially improve surgical skills; however, the scenarios for such training modules need to consider especially the bimanual coordination of hands and should be regularly adapted to the individual skill levels and progresses.
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Affiliation(s)
| | | | | | - Sahin Hanalioglu
- Hacettepe University, Ankara, Turkey.,Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Frank RM, Rego G, Grimaldi F, Salem HS, Romeo AA, Cole BJ, Adams CR. Does Arthroscopic Simulation Training Improve Triangulation and Probing Skills? A Randomized Controlled Trial ✰. JOURNAL OF SURGICAL EDUCATION 2019; 76:1131-1138. [PMID: 30846347 DOI: 10.1016/j.jsurg.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the effectiveness of simulator training on basic arthroscopic skills utilizing a novel, low-cost arthroscopic triangulation training system. DESIGN A randomized controlled trial of subjects without prior arthroscopy training was conducted, with participants randomized to receive either a fixed protocol of simulation training on a triangulation simulation model (30 minutes of training for 4 consecutive days), or no training. On Days 1 and 5, all participants were evaluated on 3 simulated arthroscopic tasks by an independent observer. Variables analyzed included how many times portals were changed, the time it took to complete the tasks, and the task completion rate. SETTING Arthrex Inc., Naples, FL. PARTICIPANTS Thirty-six participants (92% male, average 28 ± 5 years) with no prior arthroscopy training were randomized into 2 groups, with 17 in the training group (T) and 19 in the no-training group (NT). RESULTS On Day 1, there was no difference in rate of task completion between the T group and NT groups (41% versus 53%, p = 0.52). On Day 5, significantly more participants in the T group completed all tasks compared to the NT group (100% versus 63%, p = 0.008). Participants in the T group had significantly improved task completion times on Day 5 versus Day 1 (p < 0.05). Participants in the NT group had a significantly improved task completion time for Task 1 on Day 5 versus Day 1 (p = 0.037); no differences were found for Tasks 2 or 3. On Day 5, participants in the T group required significantly fewer portal changes compared to the NT group (2.35 ± 2.29 versus 6.95 ± 8.55, p = 0.039). CONCLUSIONS Simulation training on a simple, low-cost arthroscopic triangulation training system resulted in an overall improvement in arthroscopic probing and triangulation skills within 1 week of training, with significantly decreased task completion times and increased efficiency of movement.
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Affiliation(s)
- Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado, School of Medicine, Aurora, Colorado.
| | | | | | - Hytham S Salem
- Department of Orthopaedic Surgery, University of Colorado, School of Medicine, Aurora, Colorado
| | - Anthony A Romeo
- Rothman Institute New York, New York, New York; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Tulipan J, Miller A, Park AG, Labrum JT, Ilyas AM. Touch Surgery: Analysis and Assessment of Validity of a Hand Surgery Simulation "App". Hand (N Y) 2019; 14:311-316. [PMID: 29363359 PMCID: PMC6535950 DOI: 10.1177/1558944717751192] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical educators are increasingly exploring surgical simulation and other nonclinical teaching adjuncts in the education of trainees. The simulators range from purpose-built machines to inexpensive smartphone or tablet-based applications (apps). This study evaluates a free surgery module from one such app, Touch Surgery, in an effort to evaluate its validity and usefulness in training for hand surgery procedures across varied levels of surgical experience. METHODS Participants were divided into 3 cohorts: fellowship-trained hand surgeons, orthopedic surgery residents, and medical students. Participants were trained in the use of the Touch Surgery app. Each participant completed the Carpal Tunnel Release module 3 times, and participants' score was recorded for each trial. Participants also completed a customized Likert survey regarding their opinions on the usefulness and accuracy of the app. Statistical analysis using a 2-tailed t test and analysis of variance was performed to evaluate for performance within and between cohorts. RESULTS All cohorts performed better on average with each subsequent simulation attempt. For all attempts, the experts outperformed the novice and intermediate participants, while the intermediate cohort outperformed the novice cohort. Novice users consistently gave the app better scores for usefulness as a training tool, and demonstrated more willingness to use the product. CONCLUSIONS The study confirms app validity and usefulness by demonstrating that every cohort's simulator performance improved with consecutive use, and participants with higher levels of training performed better. Also, user confidence in this app's veracity and utility increased with lower levels of training experience.
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Affiliation(s)
- Jacob Tulipan
- Thomas Jefferson University,
Philadelphia, PA, USA,Jacob Tulipan, Orthopaedic Surgery, Sidney
Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, Room
516 College, Philadelphia, PA 19107-5005, USA.
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Walbron P, Thomazeau H, Sirveaux F. „Virtual reality simulation“ in der Orthopädie und Unfallchirurgie in Frankreich. Unfallchirurg 2019; 122:439-443. [DOI: 10.1007/s00113-019-0649-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Corrêa CG, Nunes FL, Ranzini E, Nakamura R, Tori R. Haptic interaction for needle insertion training in medical applications: The state-of-the-art. Med Eng Phys 2019; 63:6-25. [DOI: 10.1016/j.medengphy.2018.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/18/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
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Abstract
Simulation training plays a paramount role in medicine, especially when it comes to mastering surgical skills. By simulating, students gain not only confidence, but expertise, learning to apply theory in a safe environment. As the technological arsenal improved, virtual reality and physical simulators have developed and are now an important part of the Neurosurgery training curriculum. Based on deliberate practice in a controlled space, simulation allows psychomotor skills augment without putting neither patients nor students at risk. When compared to the master-apprentice ongoing model of teaching, simutation becomes even more appealing as it is time-efficient, shortening the learning curve and ultimately leading to error reduction, which is reflected by diminished health care costs in the long run. In this chapter we will discuss the current state of neurosurgery simulation, highlight the potential benefits of this approach, assessing specific training methods and making considerations towards the future of neurosurgical simulation.
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Affiliation(s)
| | - Eberval Gadelha Figueiredo
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
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Abstract
INTRODUCTION A surgical simulation platform has been developed to simulate fluoroscopically guided surgical procedures by coupling computer modeling with a force-feedback device as a training tool for orthopaedic resident education in an effort to enhance motor skills and potentially minimize radiation exposure. The objective of this study was to determine whether the simulation platform can distinguish between novice and experienced practitioners of percutaneous pinning of hip fractures. METHODS Medical students, orthopaedic residents, orthopaedic trauma fellows, and attending surgeons completed in situ hip-pinning simulation that recorded performance measures related to surgical accuracy, time, and use of fluoroscopy. Linear regression models were used to compare the association between performance and practitioner experience. RESULTS Notable associations were shown between performance and practitioner experience in 10 of the 15 overall measures (P < 0.05) and 9 of 11 surgical accuracy parameters (P < 0.05). CONCLUSION This novel simulation platform can distinguish between novice and experienced practitioners and defines a performance curve for completion of simulated in situ hip pinning. This important first step lays the groundwork for subsequent validation studies, which will seek to demonstrate the efficacy of this simulator in improving clinical performance by trainees completing a sequence of skills-training modules.
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Rashed S, Ahrens PM, Maruthainar N, Garlick N, Saeed MZ. The Role of Arthroscopic Simulation in Teaching Surgical Skills. JBJS Rev 2018; 6:e8. [DOI: 10.2106/jbjs.rvw.17.00201] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kholinne E, Gandhi MJ, Adikrishna A, Hong H, Kim H, Hong J, Jeon IH. The Dimensionless Squared Jerk: An Objective Parameter That Improves Assessment of Hand Motion Analysis during Simulated Shoulder Arthroscopy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7816160. [PMID: 30105247 PMCID: PMC6076914 DOI: 10.1155/2018/7816160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/04/2018] [Accepted: 06/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Attempts to quantify hand movements of surgeons during arthroscopic surgery faced limited progress beyond motion analysis of hands and/or instruments. Surrogate markers such as procedure time have been used. The dimensionless squared jerk (DSJ) is a measure of deliberate hand movements. This study tests the ability of DSJ to differentiate novice and expert surgeons (construct validity) whilst performing simulated arthroscopic shoulder surgical tasks. METHODS Six residents (novice group) and six consultants (expert group) participated in this study. Participants performed three validated tasks sequentially under the same experimental setup (one performance). Each participant had ten performances assessed. Hand movements were recorded with optical tracking system. The DSJ, time taken, total path length, multiple measures of acceleration, and number of movements were recorded. RESULTS There were significant differences between novices and experts when assessed using time, number of movements with average and minimal acceleration threshold, and DSJ. No significant differences were observed in maximum acceleration, total path length, and number of movements with 10m/s2 acceleration threshold. CONCLUSION DSJ is an objective parameter that can differentiate novice and expert surgeons' simulated arthroscopic performances. We propose DSJ as an adjunct to more conventional parameters for arthroscopic surgery skills assessment.
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Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Maulik J. Gandhi
- Upper Limb Department, Robert Jones & Agnes Hunt Hospital, Oswestry, England, UK
| | - Arnold Adikrishna
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hanpyo Hong
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Haewon Kim
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jaesung Hong
- Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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A radiopaque 3D printed, anthropomorphic phantom for simulation of CT-guided procedures. Eur Radiol 2018; 28:4818-4823. [PMID: 29789910 DOI: 10.1007/s00330-018-5481-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop an anthropomorphic phantom closely mimicking patient anatomy and to evaluate the phantom for the simulation of computed tomography (CT)-guided procedures. METHODS Patient CT images were printed with aqueous potassium iodide solution (1 g/mL) on paper. The printed paper sheets were stacked in alternation with 1-mm thick polyethylene foam layers, cut to the patient shape and glued together to create an anthropomorphic abdomen phantom. Ten interventional radiologists performed periradicular infiltration on the phantom and rated the phantom procedure regarding different aspects of suitability for simulating CT-guided procedures. RESULTS Radiopaque printing in combination with polyethylene foam layers achieved a phantom with detailed patient anatomy that allowed needle placement. CT-guided periradicular infiltration on the phantom was rated highly realistic for simulation of anatomy, needle navigation and overall course of the procedure. Haptics were rated as intermediately realistic. Participants strongly agreed that the phantom was suitable for training and learning purposes. CONCLUSIONS A radiopaque 3D printed, anthropomorphic phantom provides a realistic platform for the simulation of CT-guided procedures. Future work will focus on application for training and procedure optimisation. KEY POINTS • Radiopaque 3D printing combined with polyethylene foam achieves patient phantoms for CT-guided procedures. • Radiopaque 3D printed, anthropomorphic phantoms allow realistic simulation of CT-guided procedures. • Realistic visual guidance is a key aspect in simulation of CT-guided procedures. • Three-dimensional printed phantoms provide a platform for training and optimisation of CT-guided procedures.
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Bartlett JD, Lawrence JE, Stewart ME, Nakano N, Khanduja V. Does virtual reality simulation have a role in training trauma and orthopaedic surgeons? Bone Joint J 2018; 100-B:559-565. [PMID: 29701089 DOI: 10.1302/0301-620x.100b5.bjj-2017-1439] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aims The aim of this study was to assess the current evidence relating to the benefits of virtual reality (VR) simulation in orthopaedic surgical training, and to identify areas of future research. Materials and Methods A literature search using the MEDLINE, Embase, and Google Scholar databases was performed. The results' titles, abstracts, and references were examined for relevance. Results A total of 31 articles published between 2004 and 2016 and relating to the objective validity and efficacy of specific virtual reality orthopaedic surgical simulators were identified. We found 18 studies demonstrating the construct validity of 16 different orthopaedic virtual reality simulators by comparing expert and novice performance. Eight studies have demonstrated skill acquisition on a simulator by showing improvements in performance with repeated use. A further five studies have demonstrated measurable improvements in operating theatre performance following a period of virtual reality simulator training. Conclusion The demonstration of 'real-world' benefits from the use of VR simulation in knee and shoulder arthroscopy is promising. However, evidence supporting its utility in other forms of orthopaedic surgery is lacking. Further studies of validity and utility should be combined with robust analyses of the cost efficiency of validated simulators to justify the financial investment required for their use in orthopaedic training. Cite this article: Bone Joint J 2018;100-B:559-65.
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Affiliation(s)
- J D Bartlett
- Cambridge University School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - J E Lawrence
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M E Stewart
- Cambridge University School of Clinical Medicine, Addenbrooke's Hospital
| | - N Nakano
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - V Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Frank RM, Wang KC, Davey A, Cotter EJ, Cole BJ, Romeo AA, Bush-Joseph CA, Bach BR, Verma NN. Utility of Modern Arthroscopic Simulator Training Models: A Meta-analysis and Updated Systematic Review. Arthroscopy 2018; 34:1650-1677. [PMID: 29366742 DOI: 10.1016/j.arthro.2017.10.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/20/2017] [Accepted: 10/18/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the utility of modern arthroscopic simulators in transferring skills learned on the model to the operating room. METHODS A meta-analysis and systematic review of all English-language studies relevant to validated arthroscopic simulation models using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines from 1999 to 2016 was performed. Data collected included the specific simulator model, the joint used, participant demographic characteristics, participant level of training, training session information, type and number of tasks, pre- and post-training assessments, and overall outcomes of simulator performance. Three independent reviewers analyzed all studies. RESULTS Fifty-seven studies with 1,698 participants met the study criteria and were included. Of the studies, 25 (44%) incorporated an arthroscopic training program into the study methods whereas 32 (56%) did not. In 46 studies (81%), the studies' respective simulator models were used to assess arthroscopic performance, whereas 9 studies (16%) used Sawbones models, 8 (14%) used cadaveric models, and 4 (7%) evaluated subject performance on a live patient in the operating room. In 21 studies (37%), simulator performance was compared with experience level, with 20 of these (95%) showing that clinical experience correlated with simulator performance. In 25 studies (44%), task performance was evaluated before and after simulator training, with 24 of these (96%) showing improvement after training. All 4 studies that included live-patient arthroscopy reported improved operating room performance after simulator training compared with the performance of subjects not participating in a training program. CONCLUSIONS This review suggests that (1) training on arthroscopic simulators improves performance on arthroscopic simulators and (2) performance on simulators for basic diagnostic arthroscopy correlates with experience level. Limited data suggest that simulator training can improve basic diagnostic arthroscopy skills in vivo. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Affiliation(s)
- Rachel M Frank
- CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, U.S.A..
| | - Kevin C Wang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Annabelle Davey
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eric J Cotter
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Charles A Bush-Joseph
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Erturan G, Alvand A, Judge A, Pollard TCB, Glyn-Jones S, Rees JL. Prior Generic Arthroscopic Volume Correlates with Hip Arthroscopic Proficiency: A Simulator Study. J Bone Joint Surg Am 2018; 100:e3. [PMID: 29298267 DOI: 10.2106/jbjs.17.00352] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Changing trends in surgical education and patient expectation are leading to proficiency models of progression and the use of simulators. Hip arthroscopy is increasingly performed and has a steep learning curve mainly addressed during fellowship training. The aim of this study was to assess the impact of previous generic arthroscopic experience on performance at a simulated hip arthroscopy task to both estimate the minimum case numbers that correlate with expert proficiency levels and help to guide selection for hip arthroscopy fellowships. METHODS Fifty-two participants were recruited to a cross-sectional study. Four consultants (expert hip arthroscopists), 28 trainees (residents and fellows), and 20 novices (interns and medical students) performed a standardized bench-top simulated hip arthroscopy task. A validated global rating scale (GRS) score and motion analysis were used to assess surgical performance. Prior arthroscopic experience was recorded from surgical electronic logbooks. Receiver operating characteristic (ROC) curve analyses were conducted to identify optimum cut-points for task proficiency at both expert and competent GRS levels. RESULTS There were significant differences (p < 0.05) between the arthroscopic ability of all experience groups based on GRS assessment and for all motion analysis metrics. There was a significant positive correlation between logbook numbers and GRS scores (p < 0.0001). ROC curve analysis demonstrated that a minimum of 610 prior arthroscopic procedures were necessary to achieve an expert GRS score, and 78 prior arthroscopic procedures were necessary for a competent score. CONCLUSIONS Performing a basic hip arthroscopy task competently requires substantial previous generic arthroscopic experience. The numbers identified in this study provide targets for residents. Program directors appointing to hip arthroscopy fellowship training posts may find these results useful as a guide during the selection process.
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Affiliation(s)
- Gurhan Erturan
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Thomas C B Pollard
- Department of Orthopaedic Surgery, Royal Berkshire Hospital, Reading, United Kingdom
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, United Kingdom
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Sandberg RP, Sherman NC, Latt LD, Hardy JC. Cigar Box Arthroscopy: A Randomized Controlled Trial Validates Nonanatomic Simulation Training of Novice Arthroscopy Skills. Arthroscopy 2017; 33:2015-2023.e3. [PMID: 28676200 DOI: 10.1016/j.arthro.2017.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 04/02/2017] [Accepted: 04/12/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was to validate the cigar box arthroscopy trainer (CBAT) as a training tool and then compare its effectiveness to didactic training and to another previously validated low-fidelity but anatomic model, the anatomic knee arthroscopy trainer (AKAT). METHODS A nonanatomic knee arthroscopy training module was developed at our institution. Twenty-four medical students with no prior arthroscopic or laparoscopic experience were enrolled as subjects. Eight subjects served as controls. The remaining 16 subjects were randomized to participate in 4 hours of either the CBAT or a previously validated AKAT. Subjects' skills were assessed by 1 of 2 faculty members through repeated attempts at performing a diagnostic knee arthroscopy on a cadaveric specimen. Objective scores were given using a minimally adapted version of the Basic Arthroscopic Knee Skill Scoring System. Total cost differences were calculated. RESULTS Seventy-five percent of subjects in the CBAT and AKAT groups succeeded in reaching minimum proficiency in the allotted time compared with 25% in the control group (P < .05). There was no significant difference in the number of attempts to reach proficiency between the CBAT and AKAT groups. The cost to build the CBAT was $44.12, whereas the cost was $324.33 for the AKAT. CONCLUSIONS This pilot study suggests the CBAT is an effective knee arthroscopy trainer that may decrease the learning curve of residents without significant cost to a residency program. This study demonstrates the need for an agreed-upon objective scoring system to properly evaluate residents and compare the effectiveness of different training tools.
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Affiliation(s)
- Rory P Sandberg
- Department of Orthopedic Surgery, University of Arizona, Tucson, Arizona, U.S.A
| | - Nathan C Sherman
- College of Medicine, University of Arizona, Tucson, Arizona, U.S.A..
| | - L Daniel Latt
- Department of Orthopedic Surgery, University of Arizona, Tucson, Arizona, U.S.A
| | - Jolene C Hardy
- Department of Orthopedic Surgery, University of Arizona, Tucson, Arizona, U.S.A
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Dhawan A. Editorial Commentary: Arthroscopic Simulation Training Need Not Be Expensive to Be Effective. Arthroscopy 2017; 33:2024-2025. [PMID: 29102016 DOI: 10.1016/j.arthro.2017.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 02/02/2023]
Abstract
In a randomized controlled trial of arthroscopic training tools, the low-cost/low-fidelity Cigar Box Arthroscopy Trainer demonstrated equivalent efficacy to the validated, and more expensive, Anatomic Knee Arthroscopy Trainer (AKAT) in the training of novice arthroscopists using a validated scoring system, the Basic Arthroscopic Knee Skill Scoring System. As simulation training and formal surgical skills training is now mandatory, residency and fellowship programs are required to incorporate training modules and equipment to maximize learning while minimizing potential for patient harm. Low-cost, low-fidelity simulation tools such as this may provide a solution to do so while minimizing costs and maximizing educational returns on investment. The value in simulation training will be in its synergistic ability to augment the traditional apprenticeship model of resident and fellow training.
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Corrêa CG, Machado MADAM, Ranzini E, Tori R, Nunes FDLS. Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block. J Appl Oral Sci 2017; 25:357-366. [PMID: 28877273 PMCID: PMC5595107 DOI: 10.1590/1678-7757-2016-0386] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. Material and Methods To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results’ analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). Results The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues’ resistance. The evaluation of visual aspects was influenced by the participants’ experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it. Conclusion The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.
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Affiliation(s)
- Cléber Gimenez Corrêa
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Laboratório de Aplicações de Informática em Saúde (LApIS), São Paulo, Brasil.,Universidade de São Paulo, Escola Politécnica, Laboratório de Tecnologias Interativas (Interlab), São Paulo, Brasil
| | | | - Edith Ranzini
- Pontifícia Universidade Católica de São Paulo, São Paulo, Brasil
| | - Romero Tori
- Universidade de São Paulo, Escola Politécnica, Laboratório de Tecnologias Interativas (Interlab), São Paulo, Brasil
| | - Fátima de Lourdes Santos Nunes
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Laboratório de Aplicações de Informática em Saúde (LApIS), São Paulo, Brasil.,Universidade de São Paulo, Escola Politécnica, Laboratório de Tecnologias Interativas (Interlab), São Paulo, Brasil
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Demirel D, Yu A, Cooper-Baer S, Dendukuri A, Halic T, Kockara S, Kockara N, Ahmadi S. A hierarchical task analysis of shoulder arthroscopy for a virtual arthroscopic tear diagnosis and evaluation platform (VATDEP). Int J Med Robot 2017; 13. [PMID: 28026107 DOI: 10.1002/rcs.1799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/05/2016] [Accepted: 11/15/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Shoulder arthroscopy is a minimally invasive surgical procedure for diagnosis and treatment of a shoulder pathology. The procedure is performed with a fiber optic camera, called arthroscope, and instruments inserted through very tiny incisions made around the shoulder. The confined shoulder space, unintuitive camera orientation and constrained instrument motions complicates the procedure. Therefore, surgical competence in arthroscopy entails extensive training especially for psychomotor skills development. Conventional arthroscopy training methods such as mannequins, cadavers or apprenticeship model have limited use attributed to their low-fidelity in realism, cost inefficiency or incurring high risk. However, virtual reality (VR) based surgical simulators offer a realistic, low cost, risk-free training and assessment platform where the trainees can repeatedly perform arthroscopy and receive quantitative feedback on their performances. Therefore, we are developing a VR based shoulder arthroscopy simulation specifically for the rotator cuff ailments that can quantify the surgery performance. Development of such a VR simulation requires a through task analysis that describes the steps and goals of the procedure, comprehensive metrics for quantitative and objective skills and surgical technique assessment. METHODS We analyzed shoulder arthroscopic rotator cuff surgeries and created a hierarchical task tree. We introduced a novel surgery metrics to reduce the subjectivity of the existing grading metrics and performed video analysis of 14 surgery recordings in the operating room (OR). We also analyzed our video analysis results with respect to the existing proposed metrics in the literature. RESULTS We used Pearson's correlation tests to find any correlations among the task times, scores and surgery specific information. We determined strong positive correlation between cleaning time vs difficulty in tying suture, cleaning time vs difficulty in passing suture, cleaning time vs scar tissue size, difficulty passing vs difficulty in tying suture, total time and difficulty of the surgery. CONCLUSION We have established a hierarchical task analysis and analyzed our performance metrics. We will further use our metrics in our VR simulator for quantitative assessment.
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Affiliation(s)
- Doga Demirel
- Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA.,Computer Science Department, University of Arkansas, Little Rock, Arkansas, USA
| | - Alexander Yu
- Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA
| | - Seth Cooper-Baer
- Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA
| | - Aditya Dendukuri
- Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA
| | - Tansel Halic
- Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA
| | - Sinan Kockara
- Computer Science Department, University of Central Arkansas, Conway, Arkansas, USA
| | - Nizamettin Kockara
- Department of Orthopedics and Traumatology, Erzincan University Medical School, Erzincan, Turkey
| | - Shahryar Ahmadi
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Abstract
With increased demands for medical aesthetics procedures and the sudden profusion of newly licensed, and unlicensed, providers who are performing these medical aesthetics procedures also comes the responsibility to shift to collective competence. Collective competence refers to what occurs among professionals in action, emphasizing the sharing of experiences, knowledge, and perceptions among those who are providing services to the medical aesthetics client. Registered nurses and medical students are not taught to perform cosmetic procedures in basic nursing or medical programs and thus require a post-entry-level education to validate their competency. The current medical aesthetics apprenticeship training approach of see one, do one, and teach one focuses on teaching technical skills and thus does not sufficiently address the ever-changing health care context and the ambiguity in practitioner role. Recent scholars highlight that when health care failed or an error has been identified, it is rarely adduced to an individual's competence but rather is more likely to be a failure of the collective team. In this article, we are advocating for a change in how medical aesthetics practitioners are trained. In particular, it advocates creating opportunities within the curricula to train practitioners as a collective body, as opposed to providing training that focuses on the individual's competence and technical skills alone.
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Jazrawi LM. Editorial Commentary: The Grapefruit: So Much More Than an Annoying Breakfast Item-A Valuable Tool for Arthroscopic Simulation Training. Arthroscopy 2017; 33:1573-1574. [PMID: 28779801 DOI: 10.1016/j.arthro.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 02/02/2023]
Abstract
As our industry is continually developing more technologically advanced and expensive virtual training equipment, the grapefruit may represent an economic and accessible approach to arthroscopic simulation. This won't replace simulators, but it could become an important tool in the armamentarium of arthroscopic educators as it provides inexpensive haptic feedback necessary to create the muscle memory pathways for the improvement of arthroscopic skills.
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Morgan M, Aydin A, Salih A, Robati S, Ahmed K. Current Status of Simulation-based Training Tools in Orthopedic Surgery: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:698-716. [PMID: 28188003 DOI: 10.1016/j.jsurg.2017.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/15/2016] [Accepted: 01/04/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence (LoE) and level of recommendation. DESIGN Medline and EMBASE library databases were searched for English language articles published between 1980 and 2016, describing orthopedic simulators or validation studies of these models. All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education. RESULTS A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study. The most commonly identified models (n = 34) and validation studies (n = 26) were for knee arthroscopy. Construct validation was the most frequent validation study attempted by authors. In all, 62% (47 of 76) of the simulator studies described arthroscopy simulators, which also contained validation studies with the highest LoE. CONCLUSIONS Orthopedic simulators are increasingly being subjected to validation studies, although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators.
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Affiliation(s)
- Michael Morgan
- School of Medicine, King's College London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
| | - Alan Salih
- Department of Orthopedic Surgery, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Shibby Robati
- Department of Orthopedic Surgery, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
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Marcheix PS, Vergnenegre G, Dalmay F, Mabit C, Charissoux JL. Learning the skills needed to perform shoulder arthroscopy by simulation. Orthop Traumatol Surg Res 2017; 103:483-488. [PMID: 28344117 DOI: 10.1016/j.otsr.2017.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/27/2016] [Accepted: 02/21/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Simulation for arthroscopy helps surgical trainees develop their surgery skills in a safe environment. This teaching technique has become more widespread in recent years because of the need to provide surgeons in training with an alternative to the current methods. We hypothesized that a resident in surgery could acquire the skills needed to perform arthroscopic shoulder surgery by working on a simulator. MATERIAL AND METHODS The study was conducted over a 4-month period from June to September 2016. All the surgeons and residents in our department participated in the study. We recorded each participant's age, sex, dominant hand, and video gaming experience. We used the Arthro Mentor™ simulator from Simbionix (now 3D Systems). Testing was carried out at the start and end of training to evaluate the participant's skills and their progression. The changes were evaluated statistically. RESULTS Fourteen surgeons were included in the study. They were split into two groups: controls and residents. There was a statistically significant improvement in the intern group between the overall pre-test score and the overall post-test score. There was no significant improvement in the overall score of the control group between the pre-test and post-test. DISCUSSION For surgeons in training, shoulder arthroscopy simulation helps them acquire the skills needed to perform arthroscopy such as hand-eye coordination, triangulation and the ability to work in three-dimensions based on two-dimensional visual information. We believe that the benefit of simulation resides in learning the skills needed to perform a surgical procedure, not in learning the procedure itself. LEVEL OF EVIDENCE III-case-control study.
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Affiliation(s)
- P-S Marcheix
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin-Luther-King, 87042 Limoges, France.
| | - G Vergnenegre
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - F Dalmay
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - C Mabit
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - J-L Charissoux
- Department of orthopedic surgery, Dupuytren university hospital, 2, avenue Martin-Luther-King, 87042 Limoges, France
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Banaszek D, You D, Chang J, Pickell M, Hesse D, Hopman WM, Borschneck D, Bardana D. Virtual Reality Compared with Bench-Top Simulation in the Acquisition of Arthroscopic Skill: A Randomized Controlled Trial. J Bone Joint Surg Am 2017; 99:e34. [PMID: 28375898 DOI: 10.2106/jbjs.16.00324] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Work-hour restrictions as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and other governing bodies have forced training programs to seek out new learning tools to accelerate acquisition of both medical skills and knowledge. As a result, competency-based training has become an important part of residency training. The purpose of this study was to directly compare arthroscopic skill acquisition in both high-fidelity and low-fidelity simulator models and to assess skill transfer from either modality to a cadaveric specimen, simulating intraoperative conditions. METHODS Forty surgical novices (pre-clerkship-level medical students) voluntarily participated in this trial. Baseline demographic data, as well as data on arthroscopic knowledge and skill, were collected prior to training. Subjects were randomized to 5-week independent training sessions on a high-fidelity virtual reality arthroscopic simulator or on a bench-top arthroscopic setup, or to an untrained control group. Post-training, subjects were asked to perform a diagnostic arthroscopy on both simulators and in a simulated intraoperative environment on a cadaveric knee. A more difficult surprise task was also incorporated to evaluate skill transfer. Subjects were evaluated using the Global Rating Scale (GRS), the 14-point arthroscopic checklist, and a timer to determine procedural efficiency (time per task). Secondary outcomes focused on objective measures of virtual reality simulator motion analysis. RESULTS Trainees on both simulators demonstrated a significant improvement (p < 0.05) in arthroscopic skills compared with baseline scores and untrained controls, both in and ex vivo. The virtual reality simulation group consistently outperformed the bench-top model group in the diagnostic arthroscopy crossover tests and in the simulated cadaveric setup. Furthermore, the virtual reality group demonstrated superior skill transfer in the surprise skill transfer task. CONCLUSIONS Both high-fidelity and low-fidelity simulation trainings were effective in arthroscopic skill acquisition. High-fidelity virtual reality simulation was superior to bench-top simulation in the acquisition of arthroscopic skills, both in the laboratory and in vivo. Further clinical investigation is needed to interpret the importance of these results.
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Affiliation(s)
- Daniel Banaszek
- 1Department of Surgery, Queen's University School of Medicine, Kingston, Ontario, Canada 2Department of Surgery, Kingston General Hospital, Kingston, Ontario, Canada
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Nwachukwu B, Gaudiani M, Hammann-Scala J, Ranawat A. A Checklist Intervention to Assess Resident Diagnostic Knee and Shoulder Arthroscopic Efficiency. JOURNAL OF SURGICAL EDUCATION 2017; 74:9-15. [PMID: 27561628 DOI: 10.1016/j.jsurg.2016.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/27/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this investigation was to apply an arthroscopic shoulder and knee checklist in the evaluation of orthopedic resident arthroscopic skill efficiency and to demonstrate the use of a surgical checklist for assessing resident surgical efficiency over the course of a surgical rotation. METHODS Orthopedic surgery residents rotating on the sports medicine service at our institution between 2011 and 2015 were enrolled in this study. Residents were administered a shoulder and knee arthroscopy assessment tool at the beginning and end of their 6-week rotation. The assessment tools consisted of checklist items for knee and shoulder arthroscopy skills. Residents were timed while performing these checklist tasks. The primary outcome measure was resident improvement as a function of time to completion for the checklist items, and the intervention was participation in a 6-week resident rotation with weekly arthroscopy didactics, cadaver simulator work, and operating room experience. A paired t test was used to compare means. RESULTS Mean time to checklist completion during week 1 among study participants for the knee checklist was 787.4 seconds for the knee checklist and 484.4 seconds at the end of the rotation. Mean time to checklist completion during week 1 among study participants for the shoulder checklist was 1655.3 seconds and 832.7 seconds for the shoulder checklist at the end of the rotation. Mean improvement in time to completion was 303 seconds (p = 0.0006, SD = 209s) and 822.6 seconds (p = 0.00008, SD = 525.2s) for the arthroscopic knee and shoulder assessments, respectively. CONCLUSIONS An arthroscopic checklist is 1 method to evaluate and assess resident efficiency and improvement during surgical training. Among residents participating in this study, we found statistically significant improvements in time for arthroscopic task completion. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Benedict Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Michael Gaudiani
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
| | | | - Anil Ranawat
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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