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Silvestre J, Weaver MJ, Ahn J, Mehta S, Slobogean GP, Reid KR, Harris MB. Establishing surgical volume benchmarks for Orthopaedic Trauma Association (OTA)-accredited fellowship training. Injury 2024; 55:111698. [PMID: 38959675 DOI: 10.1016/j.injury.2024.111698] [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: 02/09/2024] [Revised: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Case volumes of trauma centers and surgeons influence clinical outcomes following orthopaedic trauma surgery. This study quantifies surgical volume benchmarks for Orthopaedic Trauma Association (OTA)-accredited fellowship training in the United States. METHODS This was a retrospective cross-sectional study of orthopaedic trauma fellows graduating between 2018 and 2019 to 2022-2023. Case volume percentiles were calculated across categories and variability defined as the fold-difference between 90th and 10th percentiles. Temporal trends were assessed with linear regression. RESULTS 446 orthopaedic trauma fellows were included in this study. Mean reported case volume increased from 898 ± 245 in 2018-2019 to 974 ± 329 in 2022-2023 (P = 0.066). Mean case volume was 924 over the study period and mostly consisted of other (418 cases, 45 %), subtrochanteric/intertrochanteric femoral neck (84 cases, 9 %), open fracture debridement (72 cases, 8 %), pelvic ring disruption / fracture (55 cases, 6 %), acetabular fracture (41 cases, 4 %), tibial shaft fracture (39 cases, 4 %), and femoral shaft fracture (38 cases, 4 %) cases. Overall variability in total reported case volume was 2.0. Variability was greatest in distal radius fracture (14.8), amputation (9.5), fasciotomy (8.0), and proximal humerus repair (5.0). CONCLUSION Graduates from OTA-accredited fellowship training perform 924 cases on average, which exceeds the current minimum requirement of 600 cases. Case volume benchmarks can assist trainees and faculty align training goals with fellowship program strengths. More research is needed to determine evidence-based case minimum requirements for core competency training in orthopaedic trauma surgery.
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Affiliation(s)
| | | | - Jaimo Ahn
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Samir Mehta
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Boere PM, Kachooei AR, Ilyas AM. Orthopaedic Hand Surgical Simulation Training: A Review. J Hand Microsurg 2024; 16:100024. [PMID: 38855522 PMCID: PMC11144645 DOI: 10.1055/s-0043-1762895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
In recent years, new orthopaedic surgical simulation and virtual reality (VR) training models have emerged to provide unlimited education medium to an unlimited number of trainees with no time limit, especially in response to trainee work-hour restrictions. Surgical simulators range from simple wooden boxes to animal and cadaver models to three-dimensional-printed and VR simulators. The coronavirus disease 2019 pandemic further highlighted the need for at-home learning tools for orthopaedic surgical trainees. Advancement in simulating shoulder and knee arthroscopies using VR simulators surpasses the other fields in orthopaedic surgery. Despite the high degree of precision needed to operate at a microscopic level involving vessels, nerves, and the small bones of the hand, the simulation tools have limited advancement in the field of orthopaedic hand surgery. This narrative review summarizes the status of surgical simulation and training techniques available to orthopaedic hand surgical trainees, factors affecting their application, and areas in hand surgery that still lag behind their surgical subspecialty counterparts.
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Affiliation(s)
- Payton M. Boere
- Department of Orthopaedics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Amir R. Kachooei
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Asif M. Ilyas
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Schreiner B, Unger R, Herzka AS, Friess DM, Nazir OF, Brady JM. A Curricular Model for Simulation Within Orthopaedic Residency Training. JB JS Open Access 2024; 9:e23.00114. [PMID: 38572497 PMCID: PMC10984657 DOI: 10.2106/jbjs.oa.23.00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Introduction American Board of Orthopaedic Surgery/American Council on GraduateMedical Education Residency Review Committee training requirements have necessitated the need for the adoption of simulation education into existing programmatic requirements. Current guidelines focus only on interns at a potentially significant cost to programs; both in total dollar amount and time. Methods The authors aim to provide a model that can maximize utility for all resident levels, manage cost by maximizing the use of cadaveric material, and allow integration of varied industry support. Results The Oregon Health & Science University Orthopaedic education program has developed a high-fidelity training curriculum that (1) is applicable to both junior and senior residents (2) has minimized the cost per resident with the reuse of cadaveric specimens and (3) has nurtured partnerships with industry stakeholders to reduce bias in training by collaborating with most major industry representatives. Conclusion The simulation curriculum outlined in this manuscript may serve as a reference for other programs and institutions to develop their own residency educational curriculum models.
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Affiliation(s)
- Bryan Schreiner
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Robert Unger
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Andrea S. Herzka
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Darin M. Friess
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Omar F. Nazir
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Jacqueline M. Brady
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Wan T, Liu K, Li B, Wang X. Effectiveness of immersive virtual reality in orthognathic surgical education: A randomized controlled trial. J Dent Educ 2024; 88:109-117. [PMID: 37800654 DOI: 10.1002/jdd.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the efficacy of an iVR surgical training system for orthognathic surgery training in medical students. METHODS This study comprised 20 fifth year medical students who were randomly assigned to the VR or traditional group for orthognathic surgical education. All participants were initially provided a lecture on orthognathic surgery. The VR group then received 10 educational sessions using the self-developed iVR training system, whereas the traditional group received 10 sessions using technical manuals and annotated operation videos. These sessions were 40-min long in both the groups. Before the evaluation, the traditional group completed one session using the training and assessment modes to become familiar with the iVR training system. The score in the assessment mode, time to complete the procedure, number of instrument selection errors, number of prompts given by the system, number of positional and angular errors, and number of timeouts during each step were recorded to evaluate the learning effect. RESULTS The VR group achieved higher scores than the traditional group (94.67 vs. 87.65). Compared with the control group, the VR group completed the procedure more quickly, with fewer instrument selection and angular errors. No difference in the number of prompts given by the system was observed between the two groups. CONCLUSIONS The iVR surgical training system showed a better learning effect than the traditional learning method for orthognathic surgery. The iVR surgical training system may have utility as a supplement and potential substitute for the traditional surgical training method.
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Affiliation(s)
- Teng Wan
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Kai Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Biao Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
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Carbone M, Viglialoro RM, Stagnari S, Condino S, Gesi M, Scaglione M, Parchi PD. Design, Fabrication, and Preliminary Validation of Patient-Specific Spine Section Phantoms for Use in Training Spine Surgeons Outside the Operating Room/Theatre. Bioengineering (Basel) 2023; 10:1345. [PMID: 38135936 PMCID: PMC10740604 DOI: 10.3390/bioengineering10121345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Pedicle screw fixation (PSF) demands rigorous training to mitigate the risk of severe neurovascular complications arising from screw misplacement. This paper introduces a patient-specific phantom designed for PSF training, extending a portion of the learning process beyond the confines of the surgical room. Six phantoms of the thoracolumbar region were fabricated from radiological datasets, combining 3D printing and casting techniques. The phantoms were employed in three training sessions by a fifth-year resident who performed full training on all six phantoms; he/she placed a total of 57 pedicle screws. Analysis of the learning curve, focusing on time per screw and positioning accuracy, revealed attainment of an asymptotic performance level (around 3 min per screw) after 40 screws. The phantom's efficacy was evaluated by three experts and six residents, each inserting a minimum of four screws. Initial assessments confirmed face, content, and construct validity, affirming the patient-specific phantoms as a valuable training resource. These proposed phantoms exhibit great promise as an essential tool in surgical training as they exhibited a demonstrable learning effect on the PSF technique. This study lays the foundation for further exploration and underscores the potential impact of these patient-specific phantoms on the future of spinal surgical education.
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Affiliation(s)
- Marina Carbone
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Rosanna Maria Viglialoro
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Sara Stagnari
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Marco Gesi
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, 56121 Pisa, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michelangelo Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
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Plancher KD, Morrey BF, McMahon GT, Ruch DS, Petterson SC. AOA Critical Issues Symposium: Leadership and Education During and After COVID-19: Back to the Future or a New Normal. J Bone Joint Surg Am 2023; 105:1560-1564. [PMID: 37220193 DOI: 10.2106/jbjs.22.01356] [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] [Indexed: 05/25/2023]
Abstract
ABSTRACT The devastating impact of COVID-19 has reshaped how we lead and train our future surgeons in the field of orthopaedics. Overnight, leaders in our field had to dramatically shift their mindset to continue to lead a hospital, department, journal, or residency or fellowship program in the face of an unprecedented level of adversity in the history of the United States. This symposium discusses the role of physician leadership during and after a pandemic, as well as the adoption of technology for training surgeons in the field of orthopaedics.
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Affiliation(s)
- K D Plancher
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
- Weill Cornell Medical College, New York, NY
| | - B F Morrey
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
- Joe R. & Teresa Lozano Long School of Medicine, San Antonio, Texas
| | - G T McMahon
- Accreditation Council for Continuing Medical Education, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - D S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Colding-Rasmussen T, Schwarzenberg P, Horstmann PF, Ottesen CBS, Garcia JSJ, Hutchinson DJ, Malkoch M, Petersen MM, Varga P, Tierp-Wong CNE. Biomechanical Variability and Usability of a Novel Customizable Fracture Fixation Technique. Bioengineering (Basel) 2023; 10:1146. [PMID: 37892877 PMCID: PMC10604275 DOI: 10.3390/bioengineering10101146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
A novel in situ customizable osteosynthesis technique, Bonevolent™ AdhFix, demonstrates promising biomechanical properties under the expertise of a single trained operator. This study assesses inter- and intra-surgeon biomechanical variability and usability of the AdhFix osteosynthesis platform. Six surgeons conducted ten osteosyntheses on a synthetic bone fracture model after reviewing an instruction manual and completing one supervised osteosynthesis. Samples underwent 4-point bending tests at a quasi-static loading rate, and the maximum bending moment (BM), bending stiffness (BS), and AdhFix cross-sectional area (CSA: mm²) were evaluated. All constructs exhibited a consistent appearance and were suitable for biomechanical testing. The mean BM was 2.64 ± 0.57 Nm, and the mean BS was 4.35 ± 0.44 Nm/mm. Statistically significant differences were observed among the six surgeons in BM (p < 0.001) and BS (p = 0.004). Throughout ten trials, only one surgeon demonstrated a significant improvement in BM (p < 0.025), and another showed a significant improvement in BS (p < 0.01). A larger CSA corresponded to a statistically significantly higher value for BM (p < 0.001) but not for BS (p = 0.594). In conclusion, this study found consistent biomechanical stability both across and within the surgeons included, suggesting that the AdhFix osteosynthesis platform can be learned and applied with minimal training and, therefore, might be a clinically viable fracture fixation technique. The variability in BM and BS observed is not expected to have a clinical impact, but future clinical studies are warranted.
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Affiliation(s)
- Thomas Colding-Rasmussen
- Department of Orthopedic Surgery, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark;
| | - Peter Schwarzenberg
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (P.S.); (P.V.)
| | - Peter Frederik Horstmann
- Department of Orthopedic Surgery, Gentofte Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark;
| | - Casper Bent Smedegaard Ottesen
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; (C.B.S.O.); (M.M.P.)
| | - Jorge San Jacinto Garcia
- Department of Fibre and Polymer Technology, KTH Royal Institute of Technology, Brinellvägen 8, 10044 Stockholm, Sweden; (J.S.J.G.); (D.J.H.); (M.M.)
| | - Daniel John Hutchinson
- Department of Fibre and Polymer Technology, KTH Royal Institute of Technology, Brinellvägen 8, 10044 Stockholm, Sweden; (J.S.J.G.); (D.J.H.); (M.M.)
| | - Michael Malkoch
- Department of Fibre and Polymer Technology, KTH Royal Institute of Technology, Brinellvägen 8, 10044 Stockholm, Sweden; (J.S.J.G.); (D.J.H.); (M.M.)
| | - Michael Mørk Petersen
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; (C.B.S.O.); (M.M.P.)
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Peter Varga
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; (P.S.); (P.V.)
| | - Christian Nai En Tierp-Wong
- Department of Orthopedic Surgery, Hvidovre University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark;
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Tucker NJ, Nardi M, Herrera RF, Scott BL, Heare A, Stacey SC, Parry JA, Mauffrey C. Percutaneous pelvic fixation model: an affordable and realistic simulator for pelvic trauma training. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03649-0. [PMID: 37550556 DOI: 10.1007/s00590-023-03649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/11/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE To describe the construction and use of a percutaneous pelvic fixation model, evaluate its translational validity among fellowship-trained orthopedic trauma surgeons, and investigate the importance of specific criteria for effective competency-based assessment of pelvic fixation techniques. METHODS Five orthopedic trauma surgeons were asked to place percutaneous wires on a pelvic fixation model, including anterior column (antegrade/retrograde), posterior column (antegrade/retrograde), supra-acetabular, transsacral, and iliosacral. Evaluation criteria included successful wire placement, redirections, cortical breaches, procedure duration, radiation exposure, and quality of fluoroscopic views. Following completion, participants were provided a survey to rate the model. RESULTS There were no differences between approaches on successful screw placement, wire redirections, or fluoroscopic quality. Antegrade approaches to the anterior and posterior columns took longer (p = 0.008) and used more radiation (p = 0.02). There was also a trend toward more cortical breaches with the antegrade anterior column approach (p = 0.07). Median ratings among surgeons were 4 out of 5 for their overall impression and its accuracy in tactile response, positioning constraints, and fluoroscopic projections. Learning parameters considered most important to the progression of trainees (most to least important) were successful screw placement, corridor breaches, wire redirections, quality of fluoroscopic views, radiation exposure, and procedure duration. CONCLUSION In being affordable, accessible, and realistic, this percutaneous pelvic fixation model represents an opportunity to advance orthopedic surgery education globally. Future research is needed to validate the findings of this pilot study and to expand upon how trainees should be evaluated within simulations and the operating room to optimize skill progression.
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Affiliation(s)
- Nicholas J Tucker
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michele Nardi
- Orthopedics and Traumatology Unit, Azienda Ospedaliero-Universitaria Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto F Herrera
- Department of Orthopedic Surgery, Unit of Trauma and Reconstruction, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Bryan L Scott
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Austin Heare
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephen C Stacey
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua A Parry
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cyril Mauffrey
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA.
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
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Thomas G, Long S, Kurtzhals T, Connor E, Anderson DD, Karam M, Kowalski H. A Dedicated Simulator Training Curriculum Improves Resident Performance in Surgical Management of Pediatric Supracondylar Humerus Fractures. JB JS Open Access 2023; 8:e23.00031. [PMID: 37701678 PMCID: PMC10489481 DOI: 10.2106/jbjs.oa.23.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background The primary goal of including simulation in residency training is to improve technical skills while working outside of the operating room. Such simulation-related skill improvements have seldom been measured in the operating room. This is largely because uncontrolled variables, such as injury severity, patient comorbidity, and anatomical variation, can bias evaluation of an operating surgeon's skill. In this study, performance during the wire navigation phase of pediatric supracondylar humerus fracture fixation was quantitatively compared between 2 groups of orthopaedic residents: a standard training group consisting of residents who participated in a single simulator session of wire navigation training and an expanded training group consisting of residents who participated in a dedicated multifaceted wire navigation simulation training curriculum. Methods To evaluate performance in the operating room, the full sequence of fluoroscopic images collected during wire navigation was quantitatively analyzed. Objective performance metrics included number of fluoroscopic images acquired, duration from placement of the first wire to that of the final wire, and wire spread at the level of the fracture. These metrics were measured from 97 pediatric supracondylar humerus fracture pinning surgeries performed by 28 different orthopaedic residents. Results No differences were observed between the groups for wire spread in the final fluoroscopic images (t(94) = 0.75, p = 0.45), an important clinical objective of the surgery. Residents who received the expanded simulator training used significantly fewer fluoroscopic images (mean of 46 vs. 61 images, t(85) = 2.25, p < 0.03) and required less time from first to final wire placement (mean of 11.2 vs. 14.9 minutes, t(83) = 2.53, p = 0.013) than the standard training group. A post hoc review of Accreditation Council for Graduate Medical Education case logs for 24 cases from the standard training group and for 21 cases from the expanded training group indicated that, at the time of surgeries, residents who received expanded training had completed fewer comparable cases than residents in the standard training group (mean of 13 vs. 21, t(42) = 2.40 p = 0.02). Further regression analysis indicated that the expanded simulator training produced an effect comparable with that associated with completing 10.5 similar surgical case experiences. Conclusions This study demonstrates that training on a wire navigation simulator can lead to improved performance in the operating room on a critical skill for all orthopaedic residents. By taking fewer images and less time while maintaining sufficient pin spread, simulator-trained residents were objectively measured to have improved performance in comparison with residents who had not participated in the pediatric elbow simulator curriculum. Clinical Relevance As programs aim to provide safe and effective training for critical orthopaedic skills such as pinning a pediatric elbow, this study demonstrates a simulator curriculum that has demonstrated the transfer of skill from a learning environment to the operating room.
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Affiliation(s)
- Geb Thomas
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
| | - Steven Long
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Trevor Kurtzhals
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
| | - Emily Connor
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Donald D. Anderson
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, The University of Iowa, Iowa City, Iowa
| | - Matthew Karam
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Heather Kowalski
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
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Ledermann G, Kuroiwa A, González N, Silva I, Villa A. Training Program for Orthopedic Residents in Forefoot Osteotomy Skills: Transference From a Simulator to a Cadaveric Surgical Scenario. Simul Healthc 2023; 18:181-186. [PMID: 35921612 DOI: 10.1097/sih.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION An effective simulation program allows both the acquisition of surgical skills on the simulated model and the transfer of these skills to a surgical scenario. We designed a forefoot osteotomy training program and sought to determine the transferability to a cadaveric surgical scenario. METHODS Eleven orthopedic residents and 2 foot and ankle surgeons were included. A foot simulator was used. All residents were instructed on the surgical techniques of Chevron, Akin, and triple Weil osteotomies. Eight junior residents (trainees) were enrolled in a supervised simulation program. Baseline assessment was performed on the simulator with the Objective Structured Assessment of Technical Skills (OSATS) and the Imperial College Surgical Assessment Device (ICSAD). After baseline, trainees completed a training program and had a final evaluation of proficiency on the simulator and on cadaveric specimens. Three senior residents with no simulated training (controls) and experts were assessed for comparison. RESULTS All trainees improved from a baseline OSATS score of 11 points (9-20) to a final score of 35 points (33-35) in the simulator and 34 points (32-34) in the cadaveric specimen ( P < 0.01). Compared with baseline, the ICSAD results improved in path length (391 [205-544] to 131 [73-278] meters, P < 0.01) and number of movements (2756 [1258-3338] to 992 [478-1908], P < 0.01). The final OSATS and ICSAD scores did not differ from experts ( P = 0.1) and were significantly different from untrained residents ( P = 0.02). CONCLUSIONS Simulated training of Chevron, Akin, and triple Weil osteotomies in orthopedic residents improved procedural proficiency, enabling successful skill transfer to a surgical scenario in cadavers. LEVEL OF EVIDENCE II (Prospective Cohort Study).
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Affiliation(s)
- Gerardo Ledermann
- From the Departamento de Traumatología (G.L., A.K., N.G., A.V.), Facultad de Medicina, Pontificia Universidad Católica de Chile; Servicio de Traumatología (G.L., A.K.); Servicio de Salud Metropolitano Sur-Oriente; and Facultad de Medicina (I.S.), Pontificia Universidad Católica de Chile, Santiago, Chile
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Cate G, Barnes J, Cherney S, Stambough J, Bumpass D, Barnes CL, Dickinson KJ. Current status of virtual reality simulation education for orthopedic residents: the need for a change in focus. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:46. [PMID: 38013875 PMCID: PMC10032253 DOI: 10.1007/s44186-023-00120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
Introduction Advances in technology are changing surgical education. Simulation provides an important adjunct to operative experience. This pedagogy has arguably become more important in light of the COVID-19 pandemic, with resultant reduction in operative exposure for trainees. Virtual reality (VR) simulators may provide significant contribution to experiential learning; however, much of the investigative focus to date has, correctly, been on establishing validity evidence for these constructs. The aim of this work was to perform a scoping review to assess the current status of VR simulation education to determine curricular development efforts for orthopedic residents. Methods With a trained medical librarian, searches of PubMed, EMBASE, and Web of Science were conducted for all articles in the last 10 years (September 2011-September 2021). Controlled vocabulary Medical Subject Headings (MeSH) terms and natural language developed with subject matter experts describing virtual reality or VR simulation and orthopedic training were used. Two trained reviewers evaluated all abstracts for inclusion. Exclusion criteria were all articles that did not assess VR simulation education involving orthopedic residents. Data were extracted from the included full-text articles including: study design, type of participants, type of VR simulation, simulated orthopedic skill, type of educational event, learner assessment including Kirkpatrick's level, assessment of quality using the Medical Education Research Study Quality Instrument (MERSQI), and level of effectiveness (LoE). Results Initial search identified 1,394 articles, of which 61 were included in the final qualitative synthesis. The majority (54%) were published in 2019- 2021, 49% in Europe. The commonest VR simulator was ArthroS (23%) and the commonest simulated skill was knee arthroscopy (33%). The majority of studies (70%) focused on simulator validation. Twenty-three studies described an educational module or curriculum, and of the 21 (34%) educational modules, 43% were one-off events. Most modules (18/21, 86%) assessed learners at Kirkpatrick level 2. With regard to methodological quality, 44% of studies had MERSQI 11.5-15 and 89% of studies had LoE of 2. Two studies had LoE of 3. Conclusion Current literature pertaining to VR training for orthopedic residents is focused on establishing validity and rarely forms part of a curriculum. Where the focus is education, the majority are discrete educational modules and do not teach a comprehensive amalgam of orthopedic skills. This suggests focus is needed to embed VR simulation training within formal curricula efforts guided by the work of Kern, and assess the efficacy of these against patient outcomes.
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Affiliation(s)
- Graham Cate
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jack Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Steven Cherney
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jeffrey Stambough
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - David Bumpass
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - C. Lowry Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Karen J. Dickinson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR USA
- Office of Interprofessional Education, University of Arkansas for Medical Sciences, Little Rock, USA
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Sun P, Zhao Y, Men J, Ma ZR, Jiang HZ, Liu CY, Feng W. Application of Virtual and Augmented Reality Technology in Hip Surgery: Systematic Review. J Med Internet Res 2023; 25:e37599. [PMID: 36651587 PMCID: PMC10039409 DOI: 10.2196/37599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/07/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Virtual and augmented reality (VAR) represents a combination of current state-of-the-art computer and imaging technologies and has the potential to be a revolutionary technology in many surgical fields. An increasing number of investigators have developed and applied VAR in hip-related surgery with the aim of using this technology to reduce hip surgery-related complications, improve surgical success rates, and reduce surgical risks. These technologies are beginning to be widely used in hip-related preoperative operation simulation and training, intraoperative navigation tools in the operating room, and postoperative rehabilitation. OBJECTIVE With the aim of reviewing the current status of virtual reality (VR) and augmented reality (AR) in hip-related surgery and summarizing its benefits, we discussed and briefly described the applicability, advantages, limitations, and future perspectives of VR and AR techniques in hip-related surgery, such as preoperative operation simulation and training; explored the possible future applications of AR in the operating room; and discussed the bright prospects of VR and AR technologies in postoperative rehabilitation after hip surgery. METHODS We searched the PubMed and Web of Science databases using the following key search terms: ("virtual reality" OR "augmented reality") AND ("pelvis" OR "hip"). The literature on basic and clinical research related to the aforementioned key search terms, that is, studies evaluating the key factors, challenges, or problems of using of VAR technology in hip-related surgery, was collected. RESULTS A total of 40 studies and reports were included and classified into the following categories: total hip arthroplasty, hip resurfacing, femoral neck fracture, pelvic fracture, acetabular fracture, tumor, arthroscopy, and postoperative rehabilitation. Quality assessment could be performed in 30 studies. Among the clinical studies, there were 16 case series with an average score of 89 out of 100 points (89%) and 1 case report that scored 81 (SD 10.11) out of 100 points (81%) according to the Joanna Briggs Institute Critical Appraisal Checklist. Two cadaveric studies scored 85 of 100 points (85%) and 92 of 100 points (92%) according to the Quality Appraisal for Cadaveric Studies scale. CONCLUSIONS VR and AR technologies hold great promise for hip-related surgeries, especially for preoperative operation simulation and training, feasibility applications in the operating room, and postoperative rehabilitation, and have the potential to assist orthopedic surgeons in operating more accurately and safely. More comparative studies are necessary, including studies focusing on clinical outcomes and cost-effectiveness.
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Affiliation(s)
- Peng Sun
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Yao Zhao
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Jie Men
- Department of Bone and Joint Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yan tai, China
| | - Zhe-Ru Ma
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Hao-Zhuo Jiang
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Cheng-Yan Liu
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Wei Feng
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
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Kalinov T, Georgiev T, Bliznakova K, Zlatarov A, Kolev N. Assessment of students' satisfaction with virtual robotic surgery training. Heliyon 2023; 9:e12839. [PMID: 36699266 PMCID: PMC9868440 DOI: 10.1016/j.heliyon.2023.e12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Objective Nowadays, in Bulgaria there is a trend of increasing entry into the surgical field of robot-assisted surgery operations, which suggests a need for the establishment of a large number of specialists in this field in a short period. Based on these arguments, the Medical University of Varna was the first university in the country to introduce a robotic surgery training program for medical students. The study aims to investigate the medical students' satisfaction on robotic surgery training provided at Medical University of Varna with da Vinci Skills Simulator. Design During the summer semester of the academic 2020/2021 and 2021/2022 years, a pilot training of robotic surgery was conducted with 5th year students in Medicine. Within one month, the students had the opportunity to get acquainted with the simulator of da Vinci Xi robotic system. The training was divided into two modules: a two-week theoretical module and a two-week practical module. After completing the training, students filled out a questionnaire dedicated to assess their satisfaction with the proposed training. Correlation between their responses and the objective parameters assessed on the simulator was calculated. Results Thirty participants (16 men and 14 women) shared their opinion on easiness of use and usefulness of the robotic simulator in training of surgery activities. Students' responses highly evaluated both aspects with average five-point Likert scale scores of 4.3 and 4.5, respectively. 93% of the participants would continue their further education and training in robotic surgery field. In addition, there was no correlation between objective evaluation by the simulator and students responses. Conclusions Training in robotic surgery proves to be a useful approach for training students to develop skills and profession in the field of surgery. The results suggest that training in this field may be accomplished even at the student level, by exploiting the robotic surgery in realistic scenario and thus, in a timely manner to find out the surgical direction they want to be further evolved.
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Affiliation(s)
- T. Kalinov
- Department of General and Operative Surgery, Medical University, Varna, Bulgaria,First Clinic of Surgery in UMHAT “Saint Marina”, Varna, Bulgaria
| | - T. Georgiev
- Department of Medical Devices, Electronic and Information Technologies in Healthcare, Medical University, Varna, Bulgaria
| | - K. Bliznakova
- Department of Medical Devices, Electronic and Information Technologies in Healthcare, Medical University, Varna, Bulgaria,Corresponding author.
| | - A. Zlatarov
- Department of General and Operative Surgery, Medical University, Varna, Bulgaria,First Clinic of Surgery in UMHAT “Saint Marina”, Varna, Bulgaria
| | - N. Kolev
- Department of General and Operative Surgery, Medical University, Varna, Bulgaria,First Clinic of Surgery in UMHAT “Saint Marina”, Varna, Bulgaria
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Huber M, Katzky U, Müller K, Blätzinger M, Goetz W, Grechenig P, Popp D, Angerpointner K. Evaluation of a New Virtual Reality Concept Teaching K-Wire Drilling With Force Feedback Simulated Haptic in Orthopedic Skills Training. J Hand Surg Am 2022; 47:1225.e1-1225.e7. [PMID: 34857404 DOI: 10.1016/j.jhsa.2021.09.008] [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: 09/30/2020] [Revised: 07/05/2021] [Accepted: 09/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Surgical simulations are becoming increasingly relevant in musculoskeletal training. They provide the opportunity to develop surgical skills in a controlled environment while reducing the risks for patients. For K-wire internal fixation in musculoskeletal surgery, a force feedback virtual reality (VR) simulator was developed. The aim of this study was to evaluate training results using this technology and compare the results with that of standard teaching on cadavers. METHODS Twenty participants attending an AO Trauma Course during 2020 were randomly allocated in 2 groups. On day 1, group A was trained by senior surgeons using a cadaver and group B was trained by the VR simulator for K-wire insertion in the distal radius. On day 2, all participants performed K-wire insertion on the cadaver model, without assistance, to validate the training effect. RESULTS On a surgical skills test, group B performed better than group A. In group B, the entry point of the first K-wire was closer to the targeted styloid process of the radius, and the protrusion of the K-wires into soft tissue was less than that in group A. CONCLUSIONS Training with the VR simulator for K-wire insertion resulted in better surgical skills than training by a surgeon and cadaver model. CLINICAL RELEVANCE Training with the VR simulator provides the opportunity to improve and refine surgical skills without the risk of harming patients. It offers easier access, unlimited repetitions, and is more cost-effective compared with training sessions with cadavers.
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Affiliation(s)
- Michaela Huber
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany.
| | | | - Karolina Müller
- Centre for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | | | - Wolfgang Goetz
- Department of Cardiothoracic-Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Peter Grechenig
- Department of Orthopedics and Traumatology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Daniel Popp
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany
| | - Katharina Angerpointner
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany; Centre for Hand- and Elbow Surgery, Microsurgery and Plastic Surgery, Schoen Clinic München Harlaching, Munich, Germany
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15
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Goudman L, Jansen J, Billot M, Vets N, De Smedt A, Roulaud M, Rigoard P, Moens M. Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e34402. [PMID: 35536641 PMCID: PMC9131143 DOI: 10.2196/34402] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is a computer technology that immerses a user in a completely different reality. The application of VR in acute pain settings is well established. However, in chronic pain, the applications and outcome parameters influenced by VR are less clear. OBJECTIVE This review aimed to systematically identify all outcome parameters that are reported in relation to VR in patients with chronic pain. METHODS A total of 4 electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched for relevant studies. Multilevel random-effect meta-analyses were performed, whereby the standardized mean difference was chosen as the effect size to denote the difference between measurements before and after a VR intervention. RESULTS The initial database search identified 1430 studies, of which 41 (2.87%) were eventually included in the systematic review. Evidence has been found for the effects of VR on pain, functioning, mobility, functional capacity, psychological outcomes, quality of life, neuropsychological outcomes, and physical sensations. The overall effect size (a total of 194 effect sizes from 25 studies) based on a three level meta-analysis was estimated at 1.22 (95% CI 0.55-1.89; z=3.56; P<.001), in favor of improvements after a VR intervention. When categorizing effect sizes, the overall effect sizes were reported as follows: 1.60 (95% CI 0.83-2.36; z=4.09; P<.001) for the effect of VR on pain (n=31), 1.40 (95% CI 0.13-2.67; z=2.17; P=.03) for functioning (n=60), 0.49 (95% CI -0.71 to 1.68; z=0.80; P=.42) for mobility (n=24), and 0.34 (95% CI -1.52 to 2.20; z=0.36; P=.72) for functional capacity (n=21). CONCLUSIONS This systematic review revealed a broad range of outcome variables influenced by an intervention of VR technology, with statistically significant pain relief and improvements in functioning. These findings indicate that VR not only has applications in acute pain management but also in chronic pain settings, whereby VR might be able to become a promising first-line intervention as complementary therapy for patients with chronic pain. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021227016; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227016.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,STIMULUS, Vrije Universiteit Brussel, Jette, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Jette, Belgium.,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Jette, Belgium.,Research Foundation-Flanders, Brussel, Belgium
| | - Julie Jansen
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,STIMULUS, Vrije Universiteit Brussel, Jette, Belgium
| | - Maxime Billot
- PRISMATICS, Poitiers University Hospital, Poitiers, France
| | - Nieke Vets
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,STIMULUS, Vrije Universiteit Brussel, Jette, Belgium
| | - Ann De Smedt
- STIMULUS, Vrije Universiteit Brussel, Jette, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Jette, Belgium.,Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Manuel Roulaud
- PRISMATICS, Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- PRISMATICS, Poitiers University Hospital, Poitiers, France.,Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, Poitiers, France.,Pprime Institute, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,STIMULUS, Vrije Universiteit Brussel, Jette, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Jette, Belgium.,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Jette, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium
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16
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Heskin L, Galvin R, Traynor O, Simms C. Simulation in Upper and Lower Limb Trauma Skill Acquisition: A Review. Simul Healthc 2022; 17:54-65. [PMID: 34009908 DOI: 10.1097/sih.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT This review aimed to explore the published evidence with regard to the types and composition of both full- and part-task trainers to teach surgeons extremity exploration procedures in limb trauma management. Studies were included if they reported the development and/or validation of synthetic or virtual task trainers. Studies were evaluated to determine their derivation, usability, and clinical utility.A total of 638 citations were identified and 63 satisfied the inclusion criteria. Twenty-five articles addressed simulator validation and 36 addressed level of learning achieved with simulator engagement. Two studies described a dedicated limb simulator. Simulators were developed to repair limb structures including skin (n = 15), tendon (n = 7), nerve (n = 1), fascia (n = 1), muscle (n = 1), vascular (n = 24), and bone (n = 11). Considerations such as material fidelity, learning outcomes, cost or reusability, validity, and effectiveness are inconsistently reported. Future studies should address design standards for the effective production of synthetic or virtual simulators for limb trauma management.
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Affiliation(s)
- Leonie Heskin
- From the Department of Surgical Affairs, Royal College of Surgeons in Ireland (L.H., O.T.); University of Limerick (R.G.); and Trinity College Dublin (C.S.), Dublin, Ireland
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17
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Liu P, Xiao JX, Zhao C, Li X, Sun G, Yang F, Wang X. Factors Associated With the Accuracy of Depth Gauge Measurements. Front Surg 2022; 8:774682. [PMID: 35096957 PMCID: PMC8793061 DOI: 10.3389/fsurg.2021.774682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: It is important to select appropriate screws in orthopedic surgeries, as excessively long or too short a screw may results failure of the surgeries. This study explored factors that affect the accuracy of measurements in terms of the experience of the surgeons, passage of drilled holes and different depth gauges.Methods: Holes were drilled into fresh porcine femurs with skin in three passages, straight drilling through the metaphysis, straight drilling through the diaphysis, and angled drilling through the diaphysis. Surgeons with different surgical experiences measured the holes with the same depth gauge and using a vernier caliper as gold standard. The length of selected screws, and the time each surgeon spent were recorded. The measurement accuracy was compared based on the experiences of the surgeons and the passage of drilled holes. Further, parameters of depth gauges and 12-mm cortical bone screws from five different manufacturers were measured.Results: A total of 13 surgeons participated in 585 measurements in this study, and each surgeon completed 45 measurements. For the surgeons in the senior, intermediate, and junior groups, the average time spent in measurements was 689, 833, and 785 s with an accuracy of 57.0, 42.2, and 31.5%, respectively. The accuracy and measurement efficiency were significantly different among the groups of surgeons (P < 0.001). The accuracy of measurements was 45.1% for straight metaphyseal drilling, 43.6% for straight diaphyseal drilling, and 33.3% for angled diaphyseal drilling (P = 0.036). Parameters of depth gauges and screws varied among different manufacturers.Conclusion: Both observer factor and objective factors could affect the accuracy of depth gauge measurement. Increased surgeon's experience was associated with improvements in the accuracy rate and measurement efficiency of drilled holes based on the depth gauge. The accuracy rate varied with hole passages, being the lowest for angled drilled holes.
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Affiliation(s)
- Pengcheng Liu
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Joanna Xi Xiao
- School of Clinical Medicine, The National University of Ireland Galway, Galway, Ireland
| | - Chen Zhao
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Li
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guantong Sun
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Yang
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoqing Wang
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Xiaoqing Wang
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Deters DR, Hunninghake J, Ruiz J, Marquez DJ, Ramirez DJ, Coffman RV. Increase Intensive Care Staff Comfort and Proficiency With Emergent Re-sternotomy in the Post-Open-Heart Patient by Using SynDaver® Simulation. Cureus 2022; 14:e20875. [PMID: 35145782 PMCID: PMC8803376 DOI: 10.7759/cureus.20875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/05/2022] Open
Abstract
Simulation training has been used in many avenues such as aeronautics, law enforcement, and healthcare to assist in training personnel to learn a new task and perform highly technical procedures. Simulation training has demonstrated beneficial for providing low-use, high-risk jobs such as landing a plane with a complete engine failure, performing reconstructive surgery, and even emergent lifesaving procedures. Our simulation training group chose to develop our custom hands-on training to perform emergent re-sternotomy on the post-open-heart patient based upon this belief. The goal of this project was to assist the bedside intensive care nurse in their self-perception of being comfortable and proficient in helping the physician with the procedure of an emergent re-sternotomy on the post-surgical open-heart patient. Measurement of self-perception of comfort and proficient was measured with a pre/post-questionnaire. The pre/post-questionnaire results showed improvement ranging from an increase in self-scoring from 1.2 to 1.7, with statistical significance demonstrated with a p <0.05.
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19
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Park C, Lin IC, Grant JL, Dultz LA, Johnson D, Jeter S, Abdelfattah K, Luk S, Cripps M, Dumas RP. Monthly Trauma Training and Simulation Are Associated With Improved Resident Skill and Leadership. J Trauma Nurs 2022; 29:29-33. [PMID: 35007248 DOI: 10.1097/jtn.0000000000000632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Training for trauma procedures has been limited to infrequent courses with little data on longitudinal performance, and few address procedural and leadership skills with granular assessment. We implemented a novel training program that emphasized an assessment of trauma resuscitation and procedural skills. OBJECTIVE This study aimed to determine whether this program could demonstrate improvement in both skill sets in surgical trainees over time. METHODS This was a prospective, observational study at a Level I trauma center between November 2018 and May 2019. A procedural skill and simulation program was implemented to train and evaluate postgraduate year (PGY) 1-5 residents. All residents participated in an initial course on procedures such as tube thoracostomy and vascular access, followed by a final evaluation. Skills were assessed by the Likert scale (1-5, 5 noting mastery). PGY 3s and above were additionally evaluated on resuscitation. A paired t test was performed on repeat learners. RESULTS A total of 40 residents participated in the structured procedural skills and simulation program. Following completion of the program, PGY-2 scores increased from a Mdn [interquartile range, IQR] 3.0 [2.5-4.0] to 4.5 [4.2-4.5]. The PGY-3 scores increased from a Mdn [IQR] 3.95 [3.7-4.6] to 4.8 [4.6-5.0]. Eighteen residents underwent repeat simulation training, with Mdn [IQR] score increases in PGY 2s (3.7 [2.5-4.0] to end score 4.47 [4.0-4.5], p = .03) and PGY 3s (3.95 [3.7-4.6] to end score 4.81 [4.68-5.0], p = .04). Specific procedural and leadership skills also increased over time.
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Affiliation(s)
- Caroline Park
- Department of General Surgery, Division of Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas (Drs Park, Grant, Dultz, Abdelfattah, Luk, and Dumas and Ms Lin); Department of Trauma, Parkland Memorial Hospital, Dallas, Texas (Mss Johnson and Jeter); Department of Surgery, Trauma and Acute Care Surgery, University of Colorado, Boulder (Dr Cripps)
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20
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Srivastava A, Gibson M, Patel A. Low-Fidelity Arthroscopic Simulation Training in Trauma and Orthopaedic Surgery: A Systematic Review of Experimental Studies. Arthroscopy 2022; 38:190-199.e1. [PMID: 34126219 DOI: 10.1016/j.arthro.2021.05.065] [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: 02/10/2021] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify and appraise evidence assessing the effectiveness of low-fidelity arthroscopic simulation in the acquisition of arthroscopic surgical skills in a novice population. METHODS Four databases were electronically searched in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) algorithm. Studies from any year that described the use of orthopaedic, low-fidelity arthroscopic training models in novice populations were included. Questionnaires, case studies, and review studies were excluded. Risk of bias assessment was conducted using the Cochrane Collaboration's Risk of Bias Tool or the Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) checklist. RESULTS Sixteen studies were identified. Using the PRISMA algorithm, 6 studies were included with a total of 131 novice participants. Individual studies ranged from 8 to 40 novices and were of Level I to II evidence. Outcome measurements varied between studies (total 16 different outcomes used). Various outcome measures used for assessing arthroscopic surgical skills within all 6 studies demonstrated significant improvement. A cross-study subjective outcome synthesis revealed low-fidelity arthroscopic simulators reduced time to completion outcomes (2 studies, P < .05), increased Arthroscopic Surgical Skill Evaluation Tool scores (2 studies, P < .01), and confirmed face validity (2 studies) and transfer of skills to cadavers (2 studies) or live patients (1 study). Cost data were under-reported in all studies apart from one. CONCLUSIONS Arthroscopic training using low-fidelity simulators likely improves the performance of novice participants in completing basic arthroscopic procedures. These simulators may also be more cost effective and thus more implementable than their high-fidelity counterparts. LEVEL OF EVIDENCE Level II, systematic review of Level I-II studies.
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Affiliation(s)
| | - Marc Gibson
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Akash Patel
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
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21
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A systematic review of methodological principles and delivery of surgical simulation bootcamps. Am J Surg 2021; 223:1079-1087. [PMID: 34865734 DOI: 10.1016/j.amjsurg.2021.10.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/27/2021] [Accepted: 10/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The growth of "bootcamp style" simulation training in surgical practice has been exponential over the last decade. Developing and delivering a surgical bootcamp requires a significant investment. This systematic review aims to identify the key components that allow for a successful and rewarding surgical bootcamp course to be implemented that can be applied to all surgical specialities. METHODS To understand the surgical bootcamp principles and delivery mechanisms, we searched peer-reviewed, English language studies published between 2000 and 21. RESULTS From 137 articles, 14 studies with a Medical Education Research Quality Instrument Score of >11.5 were included. Most studies followed the core components; delivery at transition (12), mapping syllabus (13), multimodality delivery (14), and deliberate practice with formative feedback (12) apart from 1:1 training by only 2 studies. CONCLUSIONS Our review suggests that Surgical bootcamp can be an extremely useful education tool for trainees if 5 pillars of a boot camp are respected.
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Zhou Y, Chen W, Zhao X, He B, Huang W, Wu D, Chen J. Application evaluation of virtual reality technology in dental implant training: a new dental implant training system: A CONSORT-compliant trial. Medicine (Baltimore) 2021; 100:e27355. [PMID: 34596143 PMCID: PMC8483833 DOI: 10.1097/md.0000000000027355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
To evaluate the application of virtual reality technology in a dental implant training system.A 3-dimensional model of mandible was established by Mimics17.0 software based on the Digital Imaging and Communications in Medicine data obtained from cone beam computed tomography scanning of the patient in mandibular. Thirty physicians were divided into 2 groups. The virtual reality dental implant training system was used for group A, while conventional theoretical knowledge training and clinical demonstration were performed in group B. All young physicians have a 1-month study. After training, all the physicians in groups A and B would conduct a questionnaire survey according to the training situation, which was compared between the 2 groups. The success rate of the operation was also evaluated and compared.The median scores in the 5 dimensions of postoperative assessment of group A was 9/9/9/8/8, and of group B was 6/7/6/7/7. The scores of the 5 dimensions were significantly higher than those of group B (P < .05), indicating that group A has a better grasp of the simulator. After the training of simulated mandibular implants in group A, the deviations in the 4 dimensions of mesiodistal, buccal and tongue, depth, and angle were significantly lower than those of group B (P < .05). Group A has smaller deviations in each of the 4 dimensions than those in group B, indicating group A has a higher operation success rate.We independently develop a set of virtual surgery system for dental implant training, which can be used for teaching and training, with good operability and predictability, to achieve a breakthrough in dental implant surgery training.
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Affiliation(s)
- Yong Zhou
- Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Wanlu Chen
- Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaoxian Zhao
- School of Stomatology, Fujian Medical University, Fuzhou, Fujian, China
| | - Bingwei He
- School of Mechanical Engineering and Automation, Fuzhou University, Fujian, China
| | - Wenxiu Huang
- Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Dong Wu
- Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jiang Chen
- Affiliated Stomatological Hospital of Fujian Medical University, Fuzhou, Fujian, China
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Harsten R, Papavasiliou T, Uppal L. Simulation training in hand surgery - where are we now and where should we be? EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:853-854. [PMID: 34539082 PMCID: PMC8441041 DOI: 10.1007/s00238-021-01887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Rebecca Harsten
- Department of Plastic Surgery, Royal London Hospital, Whitechapel Rd, Whitechapel, London, E1 1FR UK
| | - Theodora Papavasiliou
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth, London, SE1 7EH UK
| | - Lauren Uppal
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth, London, SE1 7EH UK
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Simulation in shoulder arthroplasty education using three-dimensional planning software: the role of guidelines and predicted range of motion. INTERNATIONAL ORTHOPAEDICS 2021; 45:2653-2661. [PMID: 34383105 DOI: 10.1007/s00264-021-05155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
AIM To demonstrate how reverse shoulder arthroplasty (RSA) planning software could be used to improve how the trainees position glenoid and humeral implants and obtain optimal simulated range of motion (ROM). METHODS We selected four groups of five various level participants: medical student (MS), junior resident (JR), senior resident (SR), and shoulder expert (SE). Thereafter, the 20 participants planned five cases of arthritic shoulders for a RSA on a validated planning software following three phases: (1) no guidelines and no ROM feedback, (2) guidelines but no ROM feedback, and (3) guidelines and ROM feedback. We evaluated the final simulated impingement-free ROM, the choice of the implant (baseplate size, graft, glenosphere), and the glenoid implant positioning. RESULTS MS planning were significantly improved by the ROM feedback only. JR took the best advantage of both guidelines and ROM in final results. SR planning were less performant than SE into phase 1 regarding flexion, external rotation, and adduction (respectively - 10°, p = 0.03; - 11°, p = 0.003; and - 3°, p = 0,03), but reached similar results into phase 3 (respectively - 2°, p = 0.329; - 4°, p = 0.44; - 2°, p = 0.319). For MS, JR, and SR, we observed a systematic improvement in the agreement over the study course. The glenoid diameter remained highly variable even for SE. Comparing glenoid implant position to SE, the distance error decreased with advancing phases. CONCLUSION Planning software can be used as a simulation training tool to improve implant positioning in shoulder arthroplasty procedures.
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Raja BS, Choudhury AK, Paul S, Rajkumar S, Kalia RB. Online educational resources for orthopaedic residency-a narrative review. INTERNATIONAL ORTHOPAEDICS 2021; 45:1911-1922. [PMID: 34080048 PMCID: PMC8172179 DOI: 10.1007/s00264-021-05101-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
Purpose Residency programs in the medical education field are considered the keystone in the development of aptitude and skills required for practice. With the worldwide current scenario of the COVID-19 pandemic, there has been a shift in the paradigm especially in the teaching of the residents from face-to-face classes to more and more online sessions. The purpose of this study is to present a compendium of knowledge-providing sites, smartphone applications (apps), YouTube channels, and podcasts that can provide better online resource management for students in the field of orthopaedics. Methods Search terms were used for making a list of various online resources which can be of help during orthopaedic residency. An initial list of the selected websites, smartphone apps, podcasts, and YouTube channels was made. The corresponding author with years of teaching experience and faculty for post-graduate and fellowship training programs then selected the final list. Results A list of 16 websites with brief points on their content and online address along with the availability of free or paid content was identified as being appropriate. A total of 39 apps available for android/apple smartphones, nine podcasts, and 11 YouTube channels were also identified as being extremely useful and have been discussed elaborately in this article. Conclusion Online educational tools are of immense importance in imparting adequate knowledge to an orthopaedic resident and act as an adjunct to conventional teaching methods. This article focuses on presenting various online educational resources in a simple yet concise way, which may be beneficial for the current generation of residents especially in this current time of unprecedented COVID-19 pandemic.
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Affiliation(s)
- Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Surjalal Rajkumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - R B Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
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Samaratunga R, Johnson L, Gatzidis C, Swain I, Wainwright T, Middleton R. A review of participant recruitment transparency for sound validation of hip surgery simulators: a novel umbrella approach. J Med Eng Technol 2021; 45:434-456. [PMID: 34016011 DOI: 10.1080/03091902.2021.1921868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Malposition of implants is associated with complications, higher wear and increased revision rates in total hip replacement (THR) along with surgeon inexperience. Training THR residents to reach expert proficiency is affected by the high cost and resource limitations of traditional training techniques. Research in extended reality (XR) technologies can overcome such barriers. These offer a platform for learning, objective skill-monitoring and, potentially, for automated certification. Prior to their incorporation into curricula however, thorough validation must be undertaken. As validity is heavily dependent on the participants recruited, there is a need to review, scrutinise and define recruitment criteria in the absence of pre-defined standards, for sound simulator validation. A systematic review on PubMed and IEEE databases was conducted. Training simulator validation research in fracture, arthroscopy and arthroplasty relating to the hip was included. 46 validation studies were reviewed. It was observed that there was no uniformity in reporting or recruitment criteria, rendering cross-comparison challenging. This work developed Umbrella categories to help prioritise recruitment, and has formulated a detailed template of fields and guidelines for reporting criteria so that, in future, research may come to a consensus as to recruitment criteria for a hip "expert" or "novice".
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Affiliation(s)
| | - Layla Johnson
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - Christos Gatzidis
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - Ian Swain
- Faculty of Science and Technology, Bournemouth University, Poole, UK.,Orthopaedic Research Institute, Bournemouth University, UK
| | - Thomas Wainwright
- Orthopaedic Research Institute, Bournemouth University, UK.,University Hospitals Dorset NHS Foundation Trust, UK
| | - Robert Middleton
- Orthopaedic Research Institute, Bournemouth University, UK.,University Hospitals Dorset NHS Foundation Trust, UK
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Arshad A, Zaveri A, Atkinson H. Reducing orthopaedic theatre exposure during the COVID-19 lockdown: does a shift towards virtual reality-based training offer a solution? Acta Orthop 2021; 92:129-130. [PMID: PMID: 33172320 PMCID: PMC8158271 DOI: 10.1080/17453674.2020.1845437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PerspectiveOrthopaedic training in the United Kingdom has changed little from the Halstedian apprenticeship model of graduated responsibility, with the mantra "see one, do one, teach one". Whilst still relevant in surgical teaching, the current and ongoing disruption to surgical training secondary to the coronavirus disease 2019 (COVID-19) outbreak highlights the need for alternative methods of experiential surgical learning, which allow for the development of the knowledge, skills, and attitudes of orthopaedic surgeons, to be sought.
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Affiliation(s)
- Adam Arshad
- Department of Emergency Medicine, University College London Hospital; ,Correspondence:
| | - Amit Zaveri
- North Middlesex University Hospital, London, UK
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Small C, Nwafor D, Patel D, Dawoud F, Dagra A, Ciporen J, Lucke-Wold B. Crisis Management Simulation: Review of Current Experience. SUNTEXT REVIEW OF NEUROSCIENCE & PSYCHOLOGY 2021; 2:126. [PMID: 33928268 PMCID: PMC8081329 DOI: 10.51737/2766-4503.2021.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Crisis management simulation is important in training the next generation of surgeons. In this review, we highlight our experiences with the cavernous carotid injury model. We then delve into other crisis simulation models available for the neurosurgical specialty. The discussion focuses upon how these trainings can continue to evolve. Much work is yet to be done in this exciting arena and we present several avenues for future discovery. Simulation continues to be an important training tool for the surgical learner.
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Affiliation(s)
| | | | - Devan Patel
- College of Medicine, Florida State University
| | - Fakhry Dawoud
- College of Medicine, East Tennessee State University
| | | | - Jeremy Ciporen
- Department of Neurosurgery, Oregon Health and Science University
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The Impact of Unguided Trauma Simulation Practice on Novice Performance: A Randomized Controlled Trial. J Am Acad Orthop Surg 2021; 29:255-262. [PMID: 32694328 DOI: 10.5435/jaaos-d-19-00225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/28/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this investigation was to determine the impact of simulator practice on task completion time, radiation use, success rate, and overall quality in a simulation of placing a distal locking screw. METHODS This was a prospective, randomized control trial with one-to-one randomization and parallel group design. Twenty-eight volunteer novice trainees (medical and premedical students) participated. Using the TraumaVision Virtual Reality Simulator (Swemac, Sweden), subjects performed locking screw placement using the "perfect circle" technique. All subjects underwent a pretest and posttest on the simulator. The simulator group completed three additional simulator training sessions. The primary outcome variables were simulator-collected task completion time, success rate, radiation exposure time, and overall score. RESULTS No notable difference existed between groups for pretest completion time, radiation use, success rate, or overall score. No notable difference in posttest radiation use or overall procedure score was found between groups. A significant difference existed in posttest total completion time (trained = 251.2 ± 103.4; control = 497.3 ± 223.1; P = 0.001) and success rate (64.3% versus 100%; P = 0.041) between groups. In addition, a significant difference existed in variance between groups for completion time (P = 0.029). CONCLUSIONS These findings suggest that independent simulator practice leads to improved speed and success rates; however, radiation use and overall score do not improve in the same manner. The design of simulator-based curriculum must be tailored to specific educational objectives and ultimately validated in the clinical setting.
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Hybrid Spine Simulator Prototype for X-ray Free Pedicle Screws Fixation Training. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11031038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Simulation for surgical training is increasingly being considered a valuable addition to traditional teaching methods. 3D-printed physical simulators can be used for preoperative planning and rehearsal in spine surgery to improve surgical workflows and postoperative patient outcomes. This paper proposes an innovative strategy to build a hybrid simulation platform for training of pedicle screws fixation: the proposed method combines 3D-printed patient-specific spine models with augmented reality functionalities and virtual X-ray visualization, thus avoiding any exposure to harmful radiation during the simulation. Software functionalities are implemented by using a low-cost tracking strategy based on fiducial marker detection. Quantitative tests demonstrate the accuracy of the method to track the vertebral model and surgical tools, and to coherently visualize them in either the augmented reality or virtual fluoroscopic modalities. The obtained results encourage further research and clinical validation towards the use of the simulator as an effective tool for training in pedicle screws insertion in lumbar vertebrae.
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Biggs A, Tyler J, Arnander M, Pearse Y, Tennent D. Procedure-Specific Arthroscopic Simulation Using 3-Dimensional Printing. Arthrosc Tech 2021; 10:e127-e129. [PMID: 33532218 PMCID: PMC7823098 DOI: 10.1016/j.eats.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/20/2020] [Indexed: 02/03/2023] Open
Abstract
Surgical simulation offers a solution to the problems of reduced training time and surgical exposure by allowing trainees to develop surgical skills outside of the operating room in a safe, cost-effective environment. We developed a highly detailed, procedure-specific shoulder arthroscopy simulator using 3-dimesional printing with the aim of providing greater access to cost-effective simulation support to trainees.
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Affiliation(s)
| | | | | | | | - Duncan Tennent
- Address correspondence to Duncan Tennent, F.R.C.S.(Orth), Trauma and Orthopaedic Department, St George’s Hospital, Blackshaw Rd., London SW17 0QT, UK.
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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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Harato K, Kobayashi S, Toyoda T, Hasegawa T, Tsukimura Y, Niki Y. Technical Obstacles for Low-Volume Surgeons in Primary Anterior Cruciate Ligament Reconstruction. J Knee Surg 2020; 33:1238-1242. [PMID: 31284321 DOI: 10.1055/s-0039-1692674] [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] [Indexed: 02/07/2023]
Abstract
A longer surgical time will lead to postoperative complications in orthopaedic surgery. According to previous reports, surgeon volume affects a surgical time in anterior cruciate ligament (ACL) reconstruction. However, little attention has been paid to difference of a surgical time between high- and low-volume surgeons in ACL reconstruction. The purpose of the present study was to investigate the surgical time for both high- and low-volume surgeons and to clarify technical obstacles as well as the important technique to reduce the surgical time in ACL reconstruction. A total of 103 knees in 103 patients with ACL tear were enrolled. All the procedures were performed by 13 different surgeons. The surgeons were divided into two surgeon groups (high- and low-volume groups) based on the number of annual cases. The operative technique was divided into the same five steps to perform comparisons of step-by-step surgical time between the surgeon groups of different volumes. The statistical comparison was done between high- and low-volume groups in terms of surgical time in each step. Total operation times were 87.8 ± 17.6 and 129.9 ± 42.9 minutes in high- and low-volume group, respectively. Low-volume surgeons took much time in tendon harvesting and bone tunnel creation using arthroscopy. Low-volume surgeons took more time for primary ACL reconstruction, especially in tendon harvesting, compared with high-volume surgeons. Tendon harvesting was extremely important, as well as bone tunnel creation, for low-volume surgeons to reduce surgical time in primary ACL reconstruction.
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Affiliation(s)
- Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Toyoda
- Nishi Waseda Orthopaedic Surgery, Nishiwaseda Orthopedic Clinic, Tokyo, Japan
| | - Takayuki Hasegawa
- Department of Orthopedic Surgery, Saitama City Hospital, Saitama, Japan
| | - Yasunori Tsukimura
- Department of Orthopedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Safely Implementing the Direct Anterior Total Hip Arthroplasty: A Methodological Approach to Minimizing the Learning Curve. J Am Acad Orthop Surg 2020; 28:930-936. [PMID: 32015249 DOI: 10.5435/jaaos-d-19-00752] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Orthopaedic surgeons often cite concern for a learning curve as a barrier to adopting the direct anterior approach (DAA) for total hip arthroplasty (THA) while transitioning from other approaches. Studies both assessing and describing a practical approach and strategy to safely accomplish this transition, as well as the effect on clinical outcomes, are not well described. METHODS This prospective study compares a single surgeon's operative results and complications for the first consecutive 100 direct anterior THA to the last 100 consecutive posterior THA after 7 years in practice. The regimented and disciplined learning strategy used to implement the DAA is detailed in this study. The data were analyzed using univariate and multivariate regression models. RESULTS Univariate analyses identified significant differences in sex, age, Asian race, and diagnostic cause for THA between the two cohorts. Multivariate analyses controlled for these differences and showed that relative to posterior THA, direct anterior THA cases were associated with 7-minute longer procedures (P = 0.002) and lengths of stay that were 0.7 days fewer (P = 0.013). No significant differences were present in the estimated blood loss, and importantly, no significant differences in death or surgical complication rates between cohorts. DISCUSSION This study suggests that the DAA for THA can be safely implemented without the increased and adverse risk to the patient when a structured learning process is maintained and meticulously performed.
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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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Hughes R, Hallstrom B, Schemanske C, Howard PW, Wilton T. Returning to operating following COVID-19 shutdown: what can human factors tell us? Bone Joint J 2020; 102-B:1277-1278. [PMID: 32993342 DOI: 10.1302/0301-620x.102b10.bjj-2020-1450.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Richard Hughes
- Michigan Arthroplasty Registry Collaborative Quality Initiative, Michigan, USA
| | - Brian Hallstrom
- Michigan Arthroplasty Registry Collaborative Quality Initiative, Michigan, USA
| | | | | | - Tim Wilton
- National Joint Registry of England, Wales, UK
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Using Cognitive Task Analysis to train Orthopaedic Surgeons - Is it time to think differently? A systematic review. Ann Med Surg (Lond) 2020; 59:131-137. [PMID: 32994993 PMCID: PMC7511220 DOI: 10.1016/j.amsu.2020.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background Working time restraints; senior led care; and a reduction in 'out of hours' operating has resulted in less operating time for orthopaedic trainees in the United Kingdom. Therefore, there has been an attempt to overcome these challenges by implementing novel techniques. Cognitive Task Analysis (CTA) focuses on the mental steps required to complete complex procedures. It has been used in training athletes and in general surgery but is new to orthopaedic training. Aim To undertake a systematic review to analyse if CTA is beneficial to train novice surgeons in common orthopaedic and trauma procedures. Materials and methods A systematic review was performed evaluating CTA in trauma and orthopaedic surgery on MEDLINE and EMBASE. Search terms used were: 'Cognitive task', 'mental rehearsal' and 'Orthop*'']. 33 studies were originally identified. Duplicate studies were excluded (11). Articles not relating to Orthopaedic surgery were excluded (15). The CTA research ranking scale was used to evaluate the impact of the studies included. Results 7 studies were identified as appropriate for inclusion. 264 participants. 178 M, 86F. All studies showed objective or subjective benefits from CTA in orthopaedic training when compared to traditional methods. The majority of the participants highlighted high subjective satisfaction with the use of the CTA tools and reported that they proved to be excellent adjuncts to the traditional apprenticeship model. Conclusion CTA learning tools have demonstrated significant objective and subjective benefits in trauma and orthopaedic training. It is cost effective, easily accessible and allows repeated practice which is key in simulation training.
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Riedle H, Chaban R, Ghazy A, Piplat C, Dorweiler B, Franke J. Experimental determination of the suture behavior of aortic tissue in comparison to 3D printed silicone modelling material. J Mech Behav Biomed Mater 2020; 112:104033. [PMID: 32882678 DOI: 10.1016/j.jmbbm.2020.104033] [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: 10/27/2019] [Revised: 02/25/2020] [Accepted: 08/08/2020] [Indexed: 11/16/2022]
Abstract
The imitation of biological tissue in a synthetic physical model can benefit many medical applications, e.g. pre surgical planning or education. For a quantitative validation of the model's mechanical behavior, standardized testing on both, the biological original and the artificial material, is necessary. In four parts, this study focuses on the biomechanical analysis of the impact of sutures for aortic modelling using 3D printed silicone. Testing methods are developed and executed on biological and synthetic samples. The first part is the determination of the pullout strength of a single stitch. The second part is the investigation of the reduction of the tensile strength and elongation of tensile bars due to stitching. Third, the tensile testing of biological and artificial vessels repaired with an anastomosis gives information about the transferability to real surgical applications. A qualitative feedback study with surgical experts concludes the evaluation. The study reveals that the pullout strength is independent from the fiber or notch direction, but that repaired aortic tensile bars show a dependency on the fiber direction of the tissue. Additionally, the circular seam of the anastomosis provides a more stable connection than multiple single stitches. For the artificial models, the mechanical behavior mainly depends on the mechanical properties of the base silicone, here represented by the Shore A hardness, rather than the manufacturing process. When compared to the biological original the most similar material varies depending on the mechanical property in focus.
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Affiliation(s)
- Hannah Riedle
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-University of Erlangen-Nuremberg, Egerlandstr. 7-9, 91058, Erlangen, Germany.
| | - Ryan Chaban
- Cardiothoracic & Vascular Surgery and Research Platform BiomaTiCS, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ahmed Ghazy
- Cardiothoracic & Vascular Surgery and Research Platform BiomaTiCS, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Charlotte Piplat
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-University of Erlangen-Nuremberg, Egerlandstr. 7-9, 91058, Erlangen, Germany
| | - Bernhard Dorweiler
- Department of Vascular Surgery, University Medical Center Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jörg Franke
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-University of Erlangen-Nuremberg, Egerlandstr. 7-9, 91058, Erlangen, Germany
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Abstract
PURPOSE The purpose of this study is to provide an overview of the published literature on the existing educational methods used to teach surgical skills, with a specific focus on hip surgery, to orthopaedic residents. METHODS A total of 31 articles were selected from a PubMed literature search on the topic of teaching surgical skills to orthopaedic residents, and 9 articles on hip surgery are included in this review. RESULTS Although several methods are included in the published literature to teach orthopaedic residents, only arthroscopy of the knee and shoulder joint is well described. Hip arthroscopy has a steeper learning curve and thus the use of simulation training as a complementary teaching method is even more important. CONCLUSIONS Currently, open surgery skills for joint arthroplasty are largely acquired by apprenticeship learning. Simulation training in the form of virtual reality could contribute to better performance of residents, decreasing operation time and improving patient safety.
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Affiliation(s)
- Sara De Boey
- Orthopaedics and Traumatology Department, ZNA Middelheim, Antwerp, Belgium
| | - Michael Maes
- Orthopaedics and Traumatology Department, ZNA Middelheim, Antwerp, Belgium
| | - Peter Mertens
- Orthopaedics and Traumatology Department, ZNA Middelheim, Antwerp, Belgium
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Abstract
The emergence of COVID-19 as a viral pandemic in early 2020 resulted in notable changes to the daily practice, workflow, and education of orthopaedic residencies internationally. In particular, social distancing, residency restructuring, and redeployment to other services has increased heterogeneity in schedules and made the in-person gathering of trainees for education increasingly challenging. These changes may last until 2024 based on some mathematical models, resulting in notable disruptions to orthopaedic education, especially for junior residents. Therefore, in this study, we describe how we converted our in-person PGY-1 skills course into a "virtual" boot camp based on validated training modules and existing American Board of Orthopaedic Surgeons guidelines. Lessons learned from the experience and potential areas for improvement in the use of newer technology to teach cognitive knowledge and skills modules are highlighted with the hope that this can be useful to other orthopaedic residency programs, during the pandemic and also beyond.
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Abstract
Virtual Reality (VR) in orthopedic surgery has significantly increased in popularity in the areas of preoperative planning, intraoperative usage, and for education and training; however, its utilization lags behind other surgical disciplines and industries. The use of VR in orthopedics is largely focused on education and is currently endorsed by North American and European training committees. The use of VR in shoulder and elbow surgery has varying levels of evidence, from I to IV, and typically involves educational randomized controlled trials. To date, however, the terms and definitions surrounding VR technology used in the literature are often redundant, confusing, or outdated. The purpose of this review, therefore, was to characterize previous uses of VR in shoulder and elbow surgery in preoperative, intraoperative, and educational domains including trauma and elective surgery. Secondary objectives were to provide recommendations for updated terminology of immersive VR (iVR) as well as provide a framework for standardized reporting of research surrounding iVR in shoulder and elbow surgery.
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Affiliation(s)
- Ryan Lohre
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Jon J P Warner
- The Harvard Shoulder Service, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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The Changing Face of Orthopaedic Education: Searching for the New Reality After COVID-19. Arthrosc Sports Med Rehabil 2020; 2:e295-e298. [PMID: 32342048 PMCID: PMC7183965 DOI: 10.1016/j.asmr.2020.04.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has had immediate impact on the practice of medicine and on orthopaedic education. As the practice of social distancing has been put into place to help slow the spread of disease as well as to conserve medical supplies and equipment, elective surgery has come to a grinding halt. This dramatic change has forced our leaders to evaluate critically the delivery of education and skills training for our residents, fellows and all orthopaedic surgeons. We must continue to develop technologies, such as virtual meeting platforms, distance learning, simulation-based training, virtual reality and augmented reality to open up the new world of orthopaedic education.
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Lohre R, Bois AJ, Athwal GS, Goel DP. Improved Complex Skill Acquisition by Immersive Virtual Reality Training: A Randomized Controlled Trial. J Bone Joint Surg Am 2020; 102:e26. [PMID: 31972694 DOI: 10.2106/jbjs.19.00982] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been limited literature on immersive virtual reality (VR) simulation in orthopaedic education. The purpose of this multicenter, blinded, randomized controlled trial was to determine the validity and efficacy of immersive VR training in orthopaedic resident education. METHODS Nineteen senior orthopaedic residents (resident group) and 7 consultant shoulder arthroplasty surgeons (expert group) participated in the trial comparing immersive VR with traditional learning using a technical journal article as a control. The examined task focused on achieving optimal glenoid exposure. Participants completed demographic questionnaires, knowledge tests, and a glenoid exposure on fresh-frozen cadavers while being examined by blinded shoulder arthroplasty surgeons. Training superiority was determined by the outcome measures of the Objective Structured Assessment of Technical Skills (OSATS) score, a developed laboratory metric, verbal answers, and time to task completion. RESULTS Immersive VR had greater realism and was superior in teaching glenoid exposure than the control (p = 0.01). The expert group outperformed the resident group on knowledge testing (p = 0.04). The immersive VR group completed the learning activity and knowledge tests significantly faster (p < 0.001) at a mean time (and standard deviation) of 11 ± 3 minutes than the control group at 20 ± 4 minutes, performing 3 to 5 VR repeats for a reduction in learning time of 570%. The immersive VR group completed the glenoid exposure significantly faster (p = 0.04) at a mean time of 14 ± 7 minutes than the control group at 21 ± 6 minutes, with superior OSATS instrument handling scores (p = 0.03). The immersive VR group scored equivalently in surprise verbal scores (p = 0.85) and written knowledge scores (p = 1.0). CONCLUSIONS Immersive VR demonstrated substantially improved translational technical and nontechnical skills acquisition over traditional learning in senior orthopaedic residents. Additionally, the results demonstrate the face, content, construct, and transfer validity for immersive VR. CLINICAL RELEVANCE This adequately powered, randomized controlled trial demonstrated how an immersive VR system can efficiently (570%) teach a complex surgical procedure and also demonstrate improved translational skill and knowledge acquisition when compared with a traditional learning method.
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Affiliation(s)
- Ryan Lohre
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Orthopaedic Residents' Transfer of Knee Arthroscopic Abilities from the Simulator to the Operating Room. J Am Acad Orthop Surg 2020; 28:194-199. [PMID: 31415299 DOI: 10.5435/jaaos-d-19-00245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The ultimate goal for any surgical simulation program is to prove the capability of transferring the skills learned to real-life surgical scenarios. We designed an arthroscopic partial meniscectomy (APM) training program and sought to determine its ability to transfer skills to real patients. METHODS Eleven junior orthopaedic residents and three expert knee surgeons were included. A low-fidelity knee simulator was used. Trainees had two baseline assessments of completing APM on a supervised real patient and on the simulator, measured using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). After baseline, the trainees completed an APM training program and had a final evaluation of proficiency on the simulator and in real patients. Experts were also assessed for comparison. Statistical analysis was performed, assuming nonparametric behavior of variables. RESULTS All trainees improved from a base score of 14 points in real patients and 10 points on the simulator to a final score of 39 points and 36 points, respectively (P < 0.01). The final trainee simulator score did not differ from experts on the simulator and was lower in real patients (36 versus 39 points, respectively, P ≤ 0.01), which resulted in a 92% transfer ratio for the simulator. DISCUSSION Simulated training of APM in orthopaedic residents using a low-fidelity knee simulator proved to not only improve simulated proficiency but also successfully transfer skills to a real clinical scenario with a high model transfer ratio. LEVEL OF EVIDENCE Level II (Prospective Cohort Study).
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Tofte JN, Rojas EO, Anthony CA, Holte AJ, Volkmar AJ, Karam MD, Caldwell LS, Lawler EA. Intraoperative Point of View Video Capture and Surgical Segmentation in Carpal Tunnel Release: A Feasibility Analysis. JOURNAL OF SURGICAL EDUCATION 2019; 76:1663-1668. [PMID: 31221605 DOI: 10.1016/j.jsurg.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/23/2019] [Accepted: 06/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this study was to (1) examine the feasibility of intraoperative point of view video while performing open and endoscopic carpal tunnel release (CTR), (2) define surgical segments of CTR, and (3) describe the duration of various surgical steps of open versus endoscopic CTR in a teaching setting. DESIGN Fellowship trained hand surgeons reached consensus on surgical segments for CTR. Adult patients 18 and older previously indicated for CTR in clinic were eligible. Head-mounted point-of-view cameras were worn during endoscopic and open CTR by resident surgeons. Video was reviewed to determine segment duration. Independent sample t tests were used for comparison of duration by technique with statistical significance set as p < 0.05. SETTING University of Iowa Hospitals and Clinics; 200 Hawkins Dr, Iowa City, IA 52242; Tertiary Academic Medical Center. PARTICIPANTS Orthopedic Surgery Residents and Orthopedic Surgery Faculty. RESULTS Surgical segments were defined as incision, dissection of superficial soft tissue structures, transection of the carpal ligament, and surgical incision closure. Twelve of 14 video capture events yielded data. In the teaching setting, the average duration of endoscopic CTR was 609.5 seconds (±111.07) versus 547.75 seconds (±82.06) for open with p value = 0.406. No surgical segments were significantly different. Transition time from dissection to ligament transection differed significantly (p = 0.004) between endoscopic (46.88 seconds ± 19.19) and open (9.0 seconds ± 7.90) CTR. Transition time between ligament transection and closure was significantly different (p = 0.029) among endoscopic (50.5 seconds ± 15.0) and open (26.25 seconds ± 2.99) CTR. CONCLUSIONS Point-of-view video capture is feasible for the capture of video during a common hand surgery procedure. A method for managing device battery power is necessary for future applications. CTR can be defined as, and described in, individual procedure segments potentially useful for surgical education as well as efficiency improvements. Identification of surgical segments may aid the development of better objective tools for the assessment of surgeon skill and competency for common orthopedic procedures.
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Affiliation(s)
- Josef N Tofte
- University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa
| | - Edward O Rojas
- University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa.
| | - Christopher A Anthony
- University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa
| | - Andrew J Holte
- University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Alexander J Volkmar
- University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Matthew D Karam
- University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa
| | - Lindsey S Caldwell
- University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa
| | - Ericka A Lawler
- University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa
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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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Ng SC, Ong WM. Training the registrar or the fellow? Time to choose? ANZ J Surg 2019; 89:802-803. [PMID: 31379077 DOI: 10.1111/ans.15215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Suat Chin Ng
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Boxhill Hospital, Melbourne, Victoria, Australia
| | - Wei Ming Ong
- Department of Colorectal Surgery, Boxhill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Mohd S, Yusof N, Lai LL, Hossain MG, Ramalingam S, Hamid SSAB, Ng WM, Mansor A. Improving knowledge of doctors and paramedics through effective bone procurement workshop: A cognitive approach. BMC MEDICAL EDUCATION 2019; 19:238. [PMID: 31262281 PMCID: PMC6604452 DOI: 10.1186/s12909-019-1685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/25/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Procurement of bone allograft must be performed by trained personnel. Improper handling and lack of knowledge during bone procurement will lead to contamination hence jeopardizing quality of the procured bones and expose bone recipients to risks of infection in post-operative phase. Bone procurement workshop is the fundamental training programme to enhance skill among personnel who has been or will be involved in bone procurement. This study evaluated the effectiveness of the workshop contents including teaching materials by assessing the knowledge on bone procurement among the participants before and after the workshop. METHODS Bone procurement workshop was held for 2 days for doctors and paramedics. The knowledge on bone procurement was evaluated in pre- and post-assessments by answering self administration questionnaire before and after the workshop, respectively. RESULTS A total of 50 participants comprised of doctors and paramedics attended the workshop however only 15 (55.6%) doctors and 12 (44.4%) paramedics completed the assessments. Overall, the mean total score for the post-assessment (61.4%) was significantly higher (p < 0.05) than that of the pre-assessment score (32.2%). The mean values of correct responses for the post-assessment was significantly higher (p < 0.05) than that of the pre-assessment in all five topics given during the workshop. The correct responses for the pre- and the post- assessments in the respective group of the doctors and paramedics were also statistically significant (p < 0.05). In the pre-assessment, the doctors had the highest score in Surgical Approach & Reconstruction (50%) while the paramedics had the highest score in Donor Screening & Selection Criteria (33.3%). In the post-assessment, the doctors had the highest score in Donor Screening & Selection Criteria (70%) while the paramedics in Packaging & Transportation (65.8%). CONCLUSIONS The assessment managed to show that the workshop contents and teaching materials were effective in improving the cognitive knowledge of the personnel who would get involved in bone procurement under the National Donation Programme.
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Affiliation(s)
- Suhaili Mohd
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Norimah Yusof
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Lee-Lee Lai
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Md. Golam Hossain
- Department of Statistic, University of Rajshahi, Rajshahi, 6205 Bangladesh
| | - Saravana Ramalingam
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Suzina Sheikh AB Hamid
- Tissue Bank, School of Medical Science, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
| | - Wuey Min Ng
- Subang Jaya Medical Centre, 47500 Subang Jaya, Selangor Malaysia
| | - Azura Mansor
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Bohl MA, McBryan S, Spear C, Pais D, Preul MC, Wilhelmi B, Yeskel A, Turner JD, Kakarla UK, Nakaji P. Evaluation of a Novel Surgical Skills Training Course: Are Cadavers Still the Gold Standard for Surgical Skills Training? World Neurosurg 2019; 127:63-71. [DOI: 10.1016/j.wneu.2019.03.230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
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