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Testa EJ, Fadale PD. Arthroscopic Training: Historical Insights and Future Directions. J Am Acad Orthop Surg 2023; 31:1180-1188. [PMID: 37703548 DOI: 10.5435/jaaos-d-23-00254] [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: 03/23/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
Arthroscopy is an orthopaedic technique that provides surgical solutions in a minimally invasive fashion. Since its introduction, arthroscopy has become a preferred surgical approach for treating various orthopaedic pathologies, such as meniscal tears, anterior cruciate ligament ruptures, rotator cuff tears, and wrist, elbow, ankle, and hip conditions. Despite its ubiquity, surgical training in arthroscopy poses several challenges for educators and trainees. Arthroscopy involves neuromotor skills which differ from those of open surgery, such as the principles of triangulation, bimanual dexterity, and the ability to navigate a three-dimensional space on a two-dimensional screen. There remains no universally implemented curriculum for arthroscopic education within orthopaedic residency or fellowship training programs, permitting the potential for highly variable training experiences from institution to institution. Therefore, the current review seeks to highlight the history of arthroscopic education, strategies and current teaching modalities in modern arthroscopic education, and avenues for future educational pathways.
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Affiliation(s)
- Edward J Testa
- From the Department of Orthopaedic Surgery, Brown University, Warren Alpert Medical School, Providence, RI
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2
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Babalola OR, Oluwadiya KS, Madubueze C, Alabi I, Madu K, Usuanlele A. Arthroscopy and orthopedic residency: a cross-sectional study of training structure in a resource-constrained environment. Pan Afr Med J 2023; 45:42. [PMID: 37575522 PMCID: PMC10422036 DOI: 10.11604/pamj.2023.45.42.36208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/05/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction orthopedic residency training was established in the West African sub-region a few decades ago, but sub-specialty in arthroscopy has only become established in the last decade. This study was aimed at evaluating available arthroscopy training resources and their impact on skill acquisition by orthopedic residents. Methods this was a cross-sectional study involving the use of a structured online survey of consultant orthopedic surgeons and orthopedic resident doctors. Details relating to the structure of training and challenges with training and recommendations for improved training were enquired. Results one hundred and two responses were received. There were 95% males (73) and 5% (4) females among the residents and 92% (23) males and 8% (2) females among the responding consultants. Of the residents, 47% (36) were registrars while 53% (41) were senior registrars. Seventy-six percent (77) were residents and twenty-five (24%) were consultants. Didactic lectures were the most impactful available training adjunct. Only 3% (2) of the residents had access to dry laboratory sessions with no specified number of practice hours attached. There was no computer simulation laboratory or cadaveric laboratory training facility for arthroscopy training in any of the training centres. Ninety-two percent (23) of the responding consultants would prefer a 6-12-month rotation in arthroscopy for residents. Fifty-three percent (41) of the residents had regular opportunities to participate in arthroscopic surgeries. Conclusion orthopedic residency in arthroscopy in Nigeria is emerging and can be improved upon by increasing the available training resources and trained personnel.
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Affiliation(s)
- Oladimeji Ranti Babalola
- Division of Arthroscopy and Sports Medicine, Department of Orthopaedics and Trauma Surgery, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
| | | | | | - Ibrahim Alabi
- Department of Orthopedics, National Orthopaedic Hospital, Dala, Kano State, Nigeria
| | - Kenechi Madu
- Department of Orthopedics, National Orthopaedic Hospital, Enugu State, Nigeria
| | - Aikomien Usuanlele
- Division of Arthroscopy and Sports Medicine, Department of Orthopaedics and Trauma Surgery, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
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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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Zhou H, Xian C, Zhang KJ, Yang Z, Li W, Tian J. The frequency of assessment tools in arthroscopic training: a systematic review. Ann Med 2022; 54:1646-1656. [PMID: 35695551 PMCID: PMC9225735 DOI: 10.1080/07853890.2022.2085317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Multiple assessment tools are used in arthroscopic training and play an important role in feedback. However, it is not fully recognized as to the standard way to apply these tools. Our study aimed to investigate the use of assessment tools in arthroscopic training and determine whether there is an optimal way to apply various assessment tools in arthroscopic training. METHODS A search was performed using PubMed, Embase and Cochrane Library electronic databases for articles published in English from January 2000 to July 2021. Eligible for inclusion were primary research articles related to using assessment tools for the evaluation of arthroscopic skills and training environments. Studies that focussed only on therapeutic cases, did not report outcome measures of technical skills, or did not mention arthroscopic skills training were excluded. RESULTS A total of 28 studies were included for review. Multiple assessment tools were used in arthroscopic training. The most common objective metric was completion time, reported in 21 studies. Technical parameters based on simulator or external equipment, such as instrument path length, hand movement, visual parameters and injury, were also widely used. Subjective assessment tools included checklists and global rating scales (GRS). Among these, the most commonly used GRS was the Arthroscopic Surgical Skill Evaluation Tool (ASSET). Most of the studies combined objective metrics and subjective assessment scales in the evaluation of arthroscopic skill training. CONCLUSIONS Overall, both subjective and objective assessment tools can be used as feedback for basic arthroscopic skill training, but there are still differences in the frequency of application in different contexts. Despite this, combined use of subjective and objective assessment tools can be applied to more situations and skills and can be the optimal way for assessment. LEVEL OF EVIDENCE Level III, systematic review of level I to III studies. Key messagesBoth subjective and objective assessment tools can be used as feedback for basic arthroscopic skill training.Combined use of subjective and objective assessment tools can be applied to more situations and skills and can be the optimal way for assessment.
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Affiliation(s)
- Haixia Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Chengyao Xian
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Kai-Jun Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhouwen Yang
- Department of Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Tian
- Department of Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Putzer D, Dammerer D, Baldauf M, Lenze F, Liebensteiner MC, Nogler M. A Prospective Assessment of Knee Arthroscopy Skills Between Medical Students and Residents-Simulator Exercises for Partial Meniscectomy and Analysis of Learning Curves. Surg Innov 2021; 29:398-405. [PMID: 34565232 PMCID: PMC9227956 DOI: 10.1177/15533506211037792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The Covid-19 pandemic has created the largest disruption of education in history. In a response to this, we aimed to evaluate the knee arthroscopy learning curve among medical students and orthopaedic residents. Methods An arthroscopy simulator was used to compare the learning curves of two groups. Medical students with any prior knowledge of arthroscopy (n=24) were compared to a residents group (n=16). Analyzed parameters were “time to complete a task,” assessment of the movement of tools and values scoring damage to the surrounding tissues. Results After several repetitions, both groups improved their skills in terms of time and movement. Residents were on average faster, had less camera movement, and touched the cartilage tissue less often than did students. Students showed a steeper improvement curve than residents for certain parameters, as they started from a different experience level. Conclusion The participants were able to reduce the time to complete a task. There was also a decrease in possible damage to the virtual surrounding tissues. In general, the residents had better mean values, but the students had the steeper learning curve. Particularly less experienced surgeons can especially train their hand–eye coordination skills required for arthroscopy surgery. Training simulators are an important training tool that supplements cadaveric training and participation in arthroscopic operations and should be included in training.
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Affiliation(s)
- David Putzer
- Department of Orthopaedics and Traumatology – Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
- David Putzer, Department of Orthopaedics and Traumatology - Experimental Orthopaedics, Experimental Orthopedics, Medical University of Innsbruck, Sonnenburgstrasse 16, Innsbruck 6020, Austria.
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martina Baldauf
- Department of Orthopaedics and Traumatology – Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Lenze
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael C. Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Nogler
- Department of Orthopaedics and Traumatology – Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
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Kulcheski ÁL, Stieven-Filho E, Nunes CP, Milcent PAA, Dau L, I-Graells XS. Validation of an endoscopic flavectomy training model. Rev Col Bras Cir 2021; 48:e202027910. [PMID: 33978123 PMCID: PMC10683459 DOI: 10.1590/0100-6991e-20202901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to validate a lumbar spine endoscopic flavectomy simulator using the construct method and to assess the acceptability of the simulator in medical education. METHODS thirty medical students and ten video-assisted surgery experienced orthopedists performed an endoscopic flavectomy procedure in the simulator. Time, look-downs, lost instruments, respect for the stipulated edge of the ligamentum flavum, regularity of the incision, GOALS checklist (Global Operative Assessment of Laparoscopic Skills), and responses to the Likert Scale adapted for this study were analyzed. RESULTS all variables differed between groups. Procedure time was shorter in the physician group (p < 0.001). Look-downs and instrument losses were seven times greater among students than physicians. Half of the students respected the designated incision limits, compared to 80% of the physicians. In the student group, about 30% of the incisions were regular, compared to 100% in the physician group (p < 0.001). The physicians performed better in all GOALS checklist domains. All the physicians and more than 96% of the students considered the activity enjoyable, and approximately 90% believed that the model was realistic and could contribute to medical education. CONCLUSIONS the simulator could differentiate the groups' experience level, indicating construct validity, and both groups reported high acceptability.
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Affiliation(s)
- Álynson Larocca Kulcheski
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Edmar Stieven-Filho
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Carolline Popovicz Nunes
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Paul André Alain Milcent
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Leonardo Dau
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
| | - Xavier Soler I-Graells
- - Universidade Federal do Paraná (UFPR), Departamento de Cirurgia - Ortopedia e Traumatologia - Curitiba - PR - Brasil
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Milcent PAA, Kulcheski AL, Rosa FM, Dau L, Stieven Filho E. Construct Validity and Experience of Using a Low-cost Arthroscopic Knee Surgery Simulator. JOURNAL OF SURGICAL EDUCATION 2021; 78:292-301. [PMID: 32591322 DOI: 10.1016/j.jsurg.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/31/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To validate an affordable and easily reproducible arthroscopic knee surgery simulator made from simple, low-cost materials by demonstrating its ability to distinguish experienced from novice arthroscopists (i.e., construct validity). Additionally, acceptance and usefulness of the simulator in medical training and education were assessed. DESIGN The simulator was used to perform a partial meniscectomy in both menisci. External and intra-articular images obtained during the procedures were used to assess objective visual parameters. The Arthroscopic Surgical Skill Evaluation Tool and a Likert scale addressing individual perceptions about the simulator and its applicability in medical education were also used. SETTING The study was conducted at Hospital de Clínicas da Universidade Federal do Paraná, a teaching hospital in southern Brazil. PARTICIPANTS Thirty sixth-year medical students were recruited, as well as 10 orthopedic surgeons who had knee arthroscopy expertise and were members of a sports traumatology and knee arthroscopy group. RESULTS There were statistically significant differences between the groups in all objective parameters. The mean time to perform the procedure was 60% higher among students compared to surgeons. Students needed 72.5% more time on average to perform triangulations and obtained an error rate approximately twice higher in the assessment of the area removed from the menisci. Regarding Arthroscopic Surgical Skill Evaluation Tool scores, statistically significant differences were found between surgeons and students in all 8 domains and in the total score. The simulator was well accepted, as over 90% of participants found it useful for education and training, believed it contributed to teaching and assessing specific surgical steps and procedures, and reported that the task was enjoyable. CONCLUSIONS The arthroscopic knee surgery simulator was largely accepted and had good applicability in objective measurement of surgical skills, distinguishing medical students from orthopedic surgeons and thus demonstrating construct validity.
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Affiliation(s)
- Paul André Alain Milcent
- Graduate Program in Clinical Surgery, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
| | | | - Fernando Martins Rosa
- Graduate Program in Clinical Surgery, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Leonardo Dau
- Graduate Program in Clinical Surgery, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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8
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McKnight RR, Pean CA, Buck JS, Hwang JS, Hsu JR, Pierrie SN. Virtual Reality and Augmented Reality-Translating Surgical Training into Surgical Technique. Curr Rev Musculoskelet Med 2020; 13:663-674. [PMID: 32779019 PMCID: PMC7661680 DOI: 10.1007/s12178-020-09667-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW As immersive learning outside of the operating room is increasingly recognized as a valuable method of surgical training, virtual reality (VR) and augmented reality (AR) are increasingly utilized in orthopedic surgical training. This article reviews the evolving nature of these training tools and provides examples of their use and efficacy. The practical and ethical implications of incorporating this technology and its impact on both orthopedic surgeons and their patients are also discussed. RECENT FINDINGS Head-mounted displays (HMDs) represent a possible adjunct to surgical accuracy and education. While the hardware is advanced, there is still much work to be done in developing software that allows for seamless, reliable, useful integration into clinical practice and training. Surgical training is changing: AR and VR will become mainstays of future training efforts. More evidence is needed to determine which training technology translates to improved clinical performance. Volatility within the HMD industry will likely delay advances in surgical training.
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Affiliation(s)
- R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - Christian A Pean
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - J Stewart Buck
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - John S Hwang
- Department of Orthopedic Surgery, Mount Carmel, Columbus, OH, USA
- Department of Orthopedic Surgery, Orthopedic ONE, Columbus, OH, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Sarah N Pierrie
- Department of Orthopaedics and Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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Global Rating Scales for the Assessment of Arthroscopic Surgical Skills: A Systematic Review. Arthroscopy 2020; 36:1156-1173. [PMID: 31948719 DOI: 10.1016/j.arthro.2019.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate whether sufficient validity and reliability evidence exists to support the use of global rating scales (GRS) as evaluation tools in both formative assessment and competency assessment of arthroscopic procedures. METHODS A search of PubMed, Embase, and Scopus was conducted for articles published between 1990 and 2018. Studies reporting measures of validity and reliability of GRS relating to arthroscopic skills were included. Procedural checklists and other assessment tools were excluded. RESULTS A total of 39 articles met the inclusion criteria. In total, 7 de novo GRS specific for arthroscopic education and 3 pre-existing GRS repurposed 4 times for arthroscopic education were identified in the literature. The 11 GRS were used to assess 1175 surgeons 3890 times. Three GRS tools explicitly defined an arbitrary minimum competency threshold, 6 of 11 tools demonstrated construct validity-the ability to significantly discriminate between groups of differing experience-and 5 of 11 tools assessed inter-rater reliability, but only the Arthroscopic Surgical Skills Evaluation Tool demonstrated excellent inter-rater reliability. The Arthroscopic Surgical Skills Evaluation Tool was validated by 16 articles for a total of 537 surgeons for hip, knee, shoulder, and ankle arthroscopy in both simulated and clinical environments but was found to be invalid in wrist arthroscopy. The Basic Arthroscopic Knee Skill Scoring System was validated by 15 articles for a total of 497 surgeons for knee, hip, and shoulder in both clinical and simulated environments. The remaining 9 GRS were validated by 2 or fewer studies. CONCLUSIONS Overall, GRS have contributed to training, feedback, and formative assessment practices. The GRS reviewed demonstrate both construct and concurrent validity as well as reliability in multiple arthroscopic procedures in multiple joints. Currently, there is sufficient evidence to use GRS as a feedback tool. However, there is insufficient evidence for its use in high-stakes examinations or as a minimum competency assessment. LEVEL OF EVIDENCE Level III, systematic review of level I to III studies.
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Technical Obstacles in Total Knee Arthroplasty Learning: A Steps Breakdown Evaluation. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e062. [PMID: 31858072 PMCID: PMC6917279 DOI: 10.5435/jaaosglobal-d-19-00062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Total knee arthroplasty (TKA) is a common procedure practiced in both the community and academic setting and one that all orthopaedic surgery residents are expected to become competent in. The aim of this study is to determine the most common technical obstacles encountered during TKA learning. Methods This is a prospective, cohort observational study performed from September 2017 to April 2018. After routine primary TKA, faculty completed a survey of the trainees in the case through a series of 10 questions. The questions were scored on a 0 to 5 scale based on performance proficiency. Exclusion criteria included revision TKA and complex primary TKA. Participants were divided into two groups based on year in training multiplied by the number of cases performed: group 1 (junior-n = 44) was <20, whereas group 2 (senior-n = 59) was >20. Results The senior experience group scored higher for all questions (P < 0.05). Skills competency and technique were related to each other, independent of experience. When evaluating the relationships between the steps, the scores on every step were linked to the previous and following step at all experience levels (P < 0.05), with some dictating the success of the rest of the case with high significance (P < 0.01). Conclusion We have shown that most senior-level residents cannot necessarily perform all steps of a TKA proficiently, potentially leading to issues in independent practice. We have also demonstrated that residents have the most difficulty with conceptual tasks, rather than technical ones. Teaching has traditionally focused on technical skills, but this implies conceptual tasks may require more teaching focus.
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Manoharan G, Sharma N, Gallacher P. Competence in using the arthroscopy stack system: a national survey of orthopaedic trainees in the UK. Ann R Coll Surg Engl 2019; 102:149-152. [PMID: 31538799 DOI: 10.1308/rcsann.2019.0131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgeons are required to have a sound knowledge regarding all operating theatre equipment they wish to use. This is important to ensure patient safety and theatre efficiency. Arthroscopy forms a significant part of all orthopaedic subspecialty practice. Proficiency in performing arthroscopic procedures is assessed during registrar training. The aim of this survey was to determine the competence of orthopaedic trainee registrars in setting up the arthroscopy stack system and managing intraoperative problems. MATERIALS AND METHODS Electronic survey forms were sent to all orthopaedic training programme directors in the UK to be forwarded to trainees in their deanery. The electronic survey contained 13 questions aimed at determining trainee experience and competence level with working with the arthroscopy stack system. RESULTS A total of 138 responses were received from 14 deaneries in the UK. Almost all registrars had experienced intraoperative delays because of equipment malfunction that required addressing by more competent staff. However, 82% of respondents had not received any formal training for operating the arthroscopy stack system. Some 82% of registrars of ST7 grade or above, who had performed over 50 arthroscopic procedures and achieved a level 4 PBA competence, were unable to set up the stack system and successfully address these delays. CONCLUSIONS Inadequate training is delivered to orthopaedic registrars from both the training programme and arthroscopy-themed courses with regards to set-up and operation of the arthroscopy tower system. This training should be part of the curriculum to ensure patient safety and efficient theatre practice.
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Affiliation(s)
- G Manoharan
- Trauma and Orthopaedics, Robert Jones Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - N Sharma
- Trauma and Orthopaedics, Robert Jones Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - P Gallacher
- Trauma and Orthopaedics, Robert Jones Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
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Maurin M, Pozzi A, Bleedorn J, McNally TP, Cuddy LC. Teaching and proficiency assessment for arthroscopy in veterinary surgery: A 2017 survey of diplomates and residents of the American and European College of Veterinary Surgeons. Vet Surg 2018; 47:E70-E78. [DOI: 10.1111/vsu.12951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Antonio Pozzi
- Vetsuisse FacultyUniversity of Zürich Zürich Switzerland
| | - Jason Bleedorn
- Department of Surgical Sciences, School of Veterinary MedicineUniversity of Wisconsin‐Madison Madison Wisconsin
| | | | - Laura C. Cuddy
- Veterinary Specialists Ireland, Summerhill County Meath Ireland
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13
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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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Kalun P, Wagner N, Yan J, Nousiainen MT, Sonnadara RR. Surgical simulation training in orthopedics: current insights. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 9:125-131. [PMID: 29503591 PMCID: PMC5826303 DOI: 10.2147/amep.s138758] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND While the knowledge required of residents training in orthopedic surgery continues to increase, various factors, including reductions in work hours, have resulted in decreased clinical learning opportunities. Recent work suggests residents graduate from their training programs without sufficient exposure to key procedures. In response, simulation is increasingly being incorporated into training programs to supplement clinical learning. This paper reviews the literature to explore whether skills learned in simulation-based settings results in improved clinical performance in orthopedic surgery trainees. MATERIALS AND METHODS A scoping review of the literature was conducted to identify papers discussing simulation training in orthopedic surgery. We focused on exploring whether skills learned in simulation transferred effectively to a clinical setting. Experimental studies, systematic reviews, and narrative reviews were included. RESULTS A total of 15 studies were included, with 11 review papers and four experimental studies. The review articles reported little evidence regarding the transfer of skills from simulation to the clinical setting, strong evidence that simulator models discriminate among different levels of experience, varied outcome measures among studies, and a need to define competent performance in both simulated and clinical settings. Furthermore, while three out of the four experimental studies demonstrated transfer between the simulated and clinical environments, methodological study design issues were identified. CONCLUSION Our review identifies weak evidence as to whether skills learned in simulation transfer effectively to clinical practice for orthopedic surgery trainees. Given the increased reliance on simulation, there is an immediate need for comprehensive studies that focus on skill transfer, which will allow simulation to be incorporated effectively into orthopedic surgery training programs.
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Affiliation(s)
- Portia Kalun
- Office of Education Science, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Natalie Wagner
- Office of Education Science, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - James Yan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Markku T Nousiainen
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ranil R Sonnadara
- Office of Education Science, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Correspondence: Ranil R Sonnadara, Office of Education Science, Department of Surgery, McMaster University, Room 131, A.N. Bourns Science Building, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada, Email
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Rogatko CP, Warnock JJ, Bobe G, Verpaalen VD. Comparison of iatrogenic articular cartilage injury in canine stifle arthroscopy versus medial parapatellar mini-arthrotomy in a cadaveric model. Vet Surg 2017; 47:O6-O14. [DOI: 10.1111/vsu.12736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 06/13/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Cleo P. Rogatko
- Department of Clinical Sciences, College of Veterinary Medicine; Oregon State University; Corvallis Oregon
| | - Jennifer J. Warnock
- Department of Clinical Sciences, College of Veterinary Medicine; Oregon State University; Corvallis Oregon
| | - Gerd Bobe
- Department of Rangeland Sciences and The Linus Pauling Institute; Oregon State University; Corvallis Oregon
| | - Valentine D. Verpaalen
- Department of Clinical Sciences, College of Veterinary Medicine; Oregon State University; Corvallis Oregon
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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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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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Molho DA, Sylvia SM, Schwartz DL, Merwin SL, Levy IM. The Grapefruit: An Alternative Arthroscopic Tool Skill Platform. Arthroscopy 2017; 33:1567-1572. [PMID: 28502388 DOI: 10.1016/j.arthro.2017.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish the construct validity of an arthroscopic training model that teaches arthroscopic tool skills including triangulation, grasping, precision biting, implant delivery and ambidexterity and uses a whole grapefruit for its training platform. METHODS For the grapefruit training model (GTM), an arthroscope and arthroscopic instruments were introduced through portals cut in the grapefruit skin of a whole prepared grapefruit. After institutional review board approval, participants performed a set of tasks inside the grapefruit. Performance for each component was assessed by recording errors, achievement of criteria, and time to completion. A total of 19 medical students, orthopaedic surgery residents, and fellowship-trained orthopaedic surgeons were included in the analysis and were divided into 3 groups based on arthroscopic experience. One-way analysis of variance (ANOVA) and the post hoc Tukey test were used for statistical analysis. RESULTS One-way ANOVA showed significant differences in both time to completion and errors between groups, F(2, 16) = 16.10, P < .001; F(2, 16) = 17.43, P < .001. Group A had a longer time to completion and more errors than group B (P = .025, P = .019), and group B had a longer time to completion and more errors than group C (P = .023, P = .018). CONCLUSIONS The GTM is an easily assembled and an alternative arthroscopic training model that bridges the gap between box trainers, cadavers, and virtual reality simulators. Our findings suggest construct validity when evaluating its use for teaching the basic arthroscopic tool skills. As such, it is a useful addition to the arthroscopic training toolbox. CLINICAL RELEVANCE There is a need for validated low-cost arthroscopic training models that are easily accessible.
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Affiliation(s)
- David A Molho
- Albert Einstein College of Medicine, Bronx, New York, U.S.A..
| | | | | | - Sara L Merwin
- Albert Einstein College of Medicine, Bronx, New York, U.S.A.; Montefiore Department of Orthopaedic Surgery, Bronx, New York, U.S.A
| | - I Martin Levy
- Albert Einstein College of Medicine, Bronx, New York, U.S.A.; Montefiore Department of Orthopaedic Surgery, Bronx, New York, U.S.A
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Garfjeld Roberts P, Guyver P, Baldwin M, Akhtar K, Alvand A, Price AJ, Rees JL. Validation of the updated ArthroS simulator: face and construct validity of a passive haptic virtual reality simulator with novel performance metrics. Knee Surg Sports Traumatol Arthrosc 2017; 25:616-625. [PMID: 27085361 DOI: 10.1007/s00167-016-4114-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/16/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the construct and face validity of ArthroS, a passive haptic VR simulator. A secondary aim was to evaluate the novel performance metrics produced by this simulator. METHODS Two groups of 30 participants, each divided into novice, intermediate or expert based on arthroscopic experience, completed three separate tasks on either the knee or shoulder module of the simulator. Performance was recorded using 12 automatically generated performance metrics and video footage of the arthroscopic procedures. The videos were blindly assessed using a validated global rating scale (GRS). Participants completed a survey about the simulator's realism and training utility. RESULTS This new simulator demonstrated construct validity of its tasks when evaluated against a GRS (p ≤ 0.003 in all cases). Regarding it's automatically generated performance metrics, established outputs such as time taken (p ≤ 0.001) and instrument path length (p ≤ 0.007) also demonstrated good construct validity. However, two-thirds of the proposed 'novel metrics' the simulator reports could not distinguish participants based on arthroscopic experience. Face validity assessment rated the simulator as a realistic and useful tool for trainees, but the passive haptic feedback (a key feature of this simulator) is rated as less realistic. CONCLUSION The ArthroS simulator has good task construct validity based on established objective outputs, but some of the novel performance metrics could not distinguish between surgical experience. The passive haptic feedback of the simulator also needs improvement. If simulators could offer automated and validated performance feedback, this would facilitate improvements in the delivery of training by allowing trainees to practise and self-assess.
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Affiliation(s)
- Patrick Garfjeld Roberts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Paul Guyver
- MDHU Derriford, Plymouth Hospitals NHS Trust, Oxford, UK
| | | | - Kash Akhtar
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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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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21
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Goyal S, Radi MA, Ramadan IKA, Said HG. Arthroscopic skills assessment and use of box model for training in arthroscopic surgery using Sawbones - "FAST" workstation. SICOT J 2016; 2:37. [PMID: 27801643 PMCID: PMC5089855 DOI: 10.1051/sicotj/2016024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/10/2016] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Arthroscopic skills training outside the operative room may decrease risks and errors by trainee surgeons. There is a need of simple objective method for evaluating proficiency and skill of arthroscopy trainees using simple bench model of arthroscopic simulator. The aim of this study is to correlate motor task performance to level of prior arthroscopic experience and establish benchmarks for training modules. METHODS Twenty orthopaedic surgeons performed a set of tasks to assess a) arthroscopic triangulation, b) navigation, c) object handling and d) meniscus trimming using SAWBONES "FAST" arthroscopy skills workstation. Time to completion and the errors were computed. The subjects were divided into four levels; "Novice", "Beginner", "Intermediate" and "Advanced" based on previous arthroscopy experience, for analyses of performance. RESULTS The task performance under transparent dome was not related to experience of the surgeon unlike opaque dome, highlighting the importance of hand-eye co-ordination required in arthroscopy. Median time to completion for each task improved as the level of experience increased and this was found to be statistically significant (p < .05) e.g. time for maze navigation (Novice - 166 s, Beginner - 135.5 s, Intermediate - 100 s, Advance - 97.5 s) and the similar results for all tasks. Majority (>85%) of subjects across all the levels reported improvement in performance with sequential tasks. CONCLUSION Use of the arthroscope requires visuo-spatial coordination which is a skill that develops with practice. This simple box model can reliably differentiate the arthroscopic skills based on experience and can be used to monitor progression of skills of trainees in institutions.
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Affiliation(s)
- Saumitra Goyal
- Orthopaedics Department, Faculty of Medicine, Assiut University Hospital, Assiut 71515, Egypt - G.G. Medical Institute and Research Centre, 106/2 Sanjay Place, Agra 282004, India
| | - Mohamed Abdel Radi
- Arthroscopy & Sports Injuries Unit, Orthopaedics Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Islam Karam-Allah Ramadan
- Arthroscopy & Sports Injuries Unit, Orthopaedics Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Hatem Galal Said
- Arthroscopy & Sports Injuries Unit, Orthopaedics Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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Mulcahey MK, Waterman BR. The Arthroscopy Association of North America Advanced Arthroscopy Traveling Fellowship: A 10-Year History. Arthroscopy 2016; 32:2179-2184. [PMID: 27697192 DOI: 10.1016/j.arthro.2016.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/06/2016] [Accepted: 06/30/2016] [Indexed: 02/02/2023]
Abstract
In its brief 10-year existence, the Arthroscopy Association of North America Advanced Arthroscopy Traveling Fellowship has quickly established itself as the paramount educational experience for aspiring young surgeons in sports medicine and arthroscopy. The Traveling Fellowship is structured as a 10-day experience with visits to 3 host sites and culminates at the AANA Annual Meeting. With 4 selected fellows and an honorary "Godfather," the Traveling Fellowship affords a unique and invaluable opportunity to forge enduring friendships and rare mentorships with established leaders in the field of Arthroscopy. Potential applicants can anticipate not only developing their surgical acumen and aspects of clinical practice, but also assimilating key leadership skills, pearls on work-life balance, and a broader commitment to life-long education. The Dr. Don Johnson AANA Traveling Fellowship Alumni Group, named in honor of the two-time godfather and AANA Past President, represent an emerging class of leaders within AANA who are poised to contribute immensely to its mission of continuing medical education and collaboration.
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Validation of a simulator for temporomandibular joint arthroscopy. Int J Oral Maxillofac Surg 2016; 45:836-41. [DOI: 10.1016/j.ijom.2016.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 10/23/2015] [Accepted: 01/19/2016] [Indexed: 11/19/2022]
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Evaluating Simulation in Training for Arthroscopic Knee Surgery: A Systematic Review of the Literature. Arthroscopy 2016; 32:1207-1220.e1. [PMID: 27030548 DOI: 10.1016/j.arthro.2016.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 11/22/2015] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the reported outcomes for measuring the effectiveness of simulation during knee arthroscopy training and determine the consistency of reporting and validation of simulation used in knee arthroscopy training. METHODS Four databases (MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials) were screened for studies involving knee arthroscopy simulation training. Inclusion and exclusion criteria were applied to the searched studies, and a quality assessment was completed for included studies. The reviewers searched the references list in each of the eligible studies to identify other relevant studies that was not captured by our search strategy. RESULTS We identified 13 eligible studies. The mean number of participants per study was 24 (range: 9 to 42 participants). The 3 most commonly reported surgical skills were the mean time to perform the task (100%), the visualization and probing tasks (77%), and the number of cartilage collisions with measurement of the surgical force (46%). The most commonly described measurement instruments included the Simulation Built-In Scoring System (54%), motion analysis system (23%), and Basic Arthroscopic Knee Skill Scoring System global rating scale (15%). The most frequently reported type of validity for the simulator was construct validity (54%) and concurrent validity (31%). Moreover, construct validity (69%) and concurrent validity (54%) were the most commonly reported type of validity for the measurement instrument. CONCLUSIONS There is significant variation in reported learning outcomes and measurement instruments for evaluating the effectiveness of knee arthroscopic simulation-based education. Despite this, time to perform a task was the most commonly reported skill-evaluating outcome of simulation. The included studies in this review were of variable strength in terms of their evidence and methodologic quality. This study highlights the need for consistent outcome reporting after arthroscopic simulation training. LEVEL OF EVIDENCE Level IV, systematic review of Level I, II, and IV studies.
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Urrutia J, Orrego M, Wright AC, Amenabar D. An assessment of the Chilean National Examination of Orthopaedic Surgery. BMC MEDICAL EDUCATION 2016; 16:78. [PMID: 26925852 PMCID: PMC4772443 DOI: 10.1186/s12909-016-0604-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Chilean National Examination of Orthopaedic Surgery (EMNOT) has been administered since 2009. It was developed to determine whether individual residents are meeting minimal knowledge standards at the end of their training programs. METHODS We performed a retrospective evaluation of the EMNOT for all years it has been administered (2009-2015). The test was analyzed for content, taxonomy of questions asked (1: direct recall; 2: diagnosis; 3: evaluation/decision-making), residents' performance, difficulty index and discrimination index. RESULTS During the years of EMNOT administration, the most frequently tested areas have been pediatric orthopaedics (22.9 %), spine (13.8 %), general orthopaedics (13.8 %) and musculoskeletal trauma (9.9 %). A significant increase in questions with images was observed, as well as a significant decrease in the percentage of Type 1 and an increase in Type 3 questions. The Difficulty Index showed a medium level of difficulty for all years the examination has been administered. The Discrimination Index showed good discrimination in 2009, fair discrimination from 2010 through 2012, and excellent discrimination from 2013 through 2015. CONCLUSION The EMNOT has evolved over several years to include better quality questions, better discrimination, and a more representative distribution of questions covering the different orthopaedic sub-specialties. This examination represents an effective instrument for quality assurance of orthopaedic residency programs in Chile.
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Affiliation(s)
- Julio Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile.
| | - Mario Orrego
- Department of Orthopaedic Surgery, Universidad de Los Andes, Santiago, Chile
| | - Ana C Wright
- Center of Medical Education, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Diego Amenabar
- Department of Orthopaedic Surgery, Universidad de Los Andes, Santiago, Chile
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Boutefnouchet T, Laios T. Transfer of arthroscopic skills from computer simulation training to the operating theatre: a review of evidence from two randomised controlled studies. SICOT J 2016; 2:4. [PMID: 27163093 PMCID: PMC4849227 DOI: 10.1051/sicotj/2015039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: There is paucity in the research on transfer validity of arthroscopic simulator training. The aim of this article is to determine whether skills derived from arthroscopic simulation are transferrable to the operating theatre and retained over time. Methods: A systematic review with rigorous criteria to identify the highest level of evidence available was carried out. The studies were critically appraised with narrative data synthesis. Results: Twenty-one studies on arthroscopic simulation were identified. Only two studies were randomised controlled trials. The first article demonstrated improved performance of basic knee arthroscopic tasks following a fixed period of training. The second article showed improved performance of arthroscopic tasks and no deterioration in the levels of skills following a period of six months. In addition, the two studies succeeded in demonstrating the importance of 3D motion analysis using computer simulators in the assessment of technical skills. Components of evaluation such as time to task completion, distance travelled by instruments and incidence of instruments collisions were associated with the highest validity and reliability of assessment. This systematic review highlighted the limitations of these two randomised studies. Discussion: Evidence from the two trials suggests that knee arthroscopy simulator training can result in improved performance. This review helped highlight the contribution of the two studies in terms of internal validity and consistency of using arthroscopic skills training. Further level I studies are however required to demonstrate the evidence for transfer and predictive validity of computer simulation as a training instrument.
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Affiliation(s)
- Tarek Boutefnouchet
- University Hospital Coventry and Warwickshire Clifford Bridge Road Walsgrave, Coventry CV2 2DX UK ; Warwick Medical School, The University of Warwick Coventry CV4 7AL UK
| | - Thomas Laios
- Department of Trauma and Orthopaedic Surgery, Heart of England NHS Foundation Trust, Heartlands Hospital Bordesley Green East Birmingham B9 5SS UK
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Gandhi MJ, Anderton MJ, Funk L. Arthroscopic Skills Acquisition Tools: An Online Simulator for Arthroscopy Training. Arthroscopy 2015; 31:1671-9. [PMID: 26070927 DOI: 10.1016/j.arthro.2015.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 02/20/2015] [Accepted: 03/13/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate correlations between objective performances measured by a new online arthroscopic skills acquisition tool (ASAT, in which "shape match" with inverted controls requires lifting shapes and releasing them into their corresponding silhouettes) and a validated virtual reality (VR) shoulder arthroscopy simulator (Insight Arthro VR; GMV, Madrid, Spain). METHODS Forty-nine medical students familiarized themselves with 5 ASATs. They were then assessed using a sixth ASAT (shape match with inverted controls) and 4 VR tasks (operating room, visualize, locate and palpate, and pendulum) on the VR simulator. Correlations were assessed between 11 ASAT measures and 15 VR measures using Pearson correlation coefficients. RESULTS Time taken and delta distance (actual distance minus minimum distance traveled) were the most frequent and correlated ASAT measures. Time taken correlated with the VR locate-and-palpate time (r = 0.596, P < .001), visualize time (r = 0.381, P = .007), and pendulum time (r = 0.646, P < .001), whereas delta distance correlated with the locate-and-palpate camera distance (r = 0.667, P < .001), instrument distance (r = 0.664, P < .001), visualize distance (r = 0.4, P = .004), pendulum camera distance (r = 0.538, P < .001), and instrument distance (r = 0.539, P < .001). CONCLUSIONS There were significant correlations between performance measures on the ASAT and a validated arthroscopic VR simulator. CLINICAL RELEVANCE Arthroscopic simulators are available but are limited by their high cost and availability. ASATs may overcome these limitations by using widely available Internet-based software and basic input devices.
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Affiliation(s)
- Maulik J Gandhi
- Orthopaedic Institute, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, England.
| | | | - Lennard Funk
- Upper Limb Unit, Wrightington Hospital, Wigan, England
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Braman JP, Sweet RM, Hananel DM, Ludewig PM, Van Heest AE. Development and validation of a basic arthroscopy skills simulator. Arthroscopy 2015; 31:104-12. [PMID: 25239171 DOI: 10.1016/j.arthro.2014.07.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to develop a low-fidelity surgical simulator for basic arthroscopic skills training, with the goal of creating a pretrained novice ready with the basic skills necessary for all joint arthroscopic procedures. METHODS A panel of education, arthroscopy, and simulation experts designed and evaluated a basic arthroscopic skills training and testing box. Task deconstruction was used to create 2 modules, which incorporate core skills common to all arthroscopic procedures. Core metrics measured were time to completion, number of trials to steady state, and number of errors. Face validity was evaluated using a questionnaire. Construct validity was examined by comparing 8 medical students with 8 expert orthopaedic surgeons. RESULTS Surgeons were faster than students on both module 1 (P = .0013), simulating triangulation skills, and module 2 (P = .0190) simulating object manipulation skills. Surgeons demonstrated fewer errors (6.9 errors versus 28.1; P = .0073). All surgeons were able to demonstrate steady state (i.e., perform 2 trials that were within 10% of each other for time to completion and errors) on both modules within 3 trials on each module. Only 2 novices were able to demonstrate steady state on either module, and both did so within 3 trials. Furthermore, face validity of the skills trainer was shown by the expert arthroscopists. CONCLUSIONS We describe a basic arthroscopy skills simulator that has face and construct validity. Our expert panel was able to design a simulator that differentiated between experienced arthroscopists and novices. CLINICAL RELEVANCE Surgical simulation is an important part of efficient surgical education. This simulator shows good construct and face validity and provides a low-fidelity option for teaching the entry-level arthroscopist.
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Affiliation(s)
- Jonathan P Braman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A..
| | - Robert M Sweet
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - David M Hananel
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Paula M Ludewig
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Ann E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
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Ponce BA, Menendez ME, Oladeji LO, Fryberger CT, Dantuluri PK. Emerging technology in surgical education: combining real-time augmented reality and wearable computing devices. Orthopedics 2014; 37:751-7. [PMID: 25361359 DOI: 10.3928/01477447-20141023-05] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/20/2014] [Indexed: 02/03/2023]
Abstract
The authors describe the first surgical case adopting the combination of real-time augmented reality and wearable computing devices such as Google Glass (Google Inc, Mountain View, California). A 66-year-old man presented to their institution for a total shoulder replacement after 5 years of progressive right shoulder pain and decreased range of motion. Throughout the surgical procedure, Google Glass was integrated with the Virtual Interactive Presence and Augmented Reality system (University of Alabama at Birmingham, Birmingham, Alabama), enabling the local surgeon to interact with the remote surgeon within the local surgical field. Surgery was well tolerated by the patient and early surgical results were encouraging, with an improvement of shoulder pain and greater range of motion. The combination of real-time augmented reality and wearable computing devices such as Google Glass holds much promise in the field of surgery.
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Frank RM, Erickson B, Frank JM, Bush-Joseph CA, Bach BR, Cole BJ, Romeo AA, Provencher MT, Verma NN. Utility of modern arthroscopic simulator training models. Arthroscopy 2014; 30:121-33. [PMID: 24290789 DOI: 10.1016/j.arthro.2013.09.084] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/19/2013] [Accepted: 09/26/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to review the published literature on modern arthroscopic simulator training models to (1) determine the ability to transfer skills learned on the model to the operating room and (2) determine the learning curve required to translate such skills. METHODS A systematic review of all studies using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. Two independent reviewers then analyzed studies deemed appropriate for inclusion. Study data collected included participant demographic characteristics, simulator model, type and number of tasks, method of analysis, and results of training, when available. Given the different methods used in each study, descriptive analysis was performed. RESULTS Nineteen studies met the inclusion criteria (9 shoulder, 9 knee, and 1 hip). A total of 465 participants with a mean age of 30 years were evaluated. Twelve studies (63%) compared task performance among participants of different experience levels, with 100% reporting a positive correlation between experience level and simulator performance. Eight studies (42%) evaluated task performance before and after simulator training, with 6 studies showing improvement after training; 1 study noted no difference in performance after 1 hour of training. One study commented on improved operating room performance after simulator training. No studies commented on the number of training sessions needed to translate skills learned on the models to the operating room. CONCLUSIONS This review suggests that practice on arthroscopic simulators improves performance on arthroscopic simulators. We cannot, however, definitively comment on whether simulator training correlates to an improved skill set in the operating room. Further work is needed to determine the type and number of training sessions needed to translate arthroscopic skills learned on the models to the operating room. LEVEL OF EVIDENCE Level IV, systematic review of studies with Level I through IV evidence.
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Affiliation(s)
- Rachel M Frank
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A..
| | - Brandon Erickson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Jonathan M Frank
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Charles A Bush-Joseph
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
| | - Matthew T Provencher
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois, U.S.A
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