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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] [MESH Headings] [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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Mergen M, Graf N, Meyerheim M. Reviewing the current state of virtual reality integration in medical education - a scoping review. BMC MEDICAL EDUCATION 2024; 24:788. [PMID: 39044186 PMCID: PMC11267750 DOI: 10.1186/s12909-024-05777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND In medical education, new technologies like Virtual Reality (VR) are increasingly integrated to enhance digital learning. Originally used to train surgical procedures, now use cases also cover emergency scenarios and non-technical skills like clinical decision-making. This scoping review aims to provide an overview of VR in medical education, including requirements, advantages, disadvantages, as well as evaluation methods and respective study results to establish a foundation for future VR integration into medical curricula. METHODS This review follows the updated JBI methodology for scoping reviews and adheres to the respective PRISMA extension. We included reviews in English or German language from 2012 to March 2022 that examine the use of VR in education for medical and nursing students, registered nurses, and qualified physicians. Data extraction focused on medical specialties, subjects, curricula, technical/didactic requirements, evaluation methods and study outcomes as well as advantages and disadvantages of VR. RESULTS A total of 763 records were identified. After eligibility assessment, 69 studies were included. Nearly half of them were published between 2021 and 2022, predominantly from high-income countries. Most reviews focused on surgical training in laparoscopic and minimally invasive procedures (43.5%) and included studies with qualified physicians as participants (43.5%). Technical, didactic and organisational requirements were highlighted and evaluations covering performance time and quality, skills acquisition and validity, often showed positive outcomes. Accessibility, repeatability, cost-effectiveness, and improved skill development were reported as advantages, while financial challenges, technical limitations, lack of scientific evidence, and potential user discomfort were cited as disadvantages. DISCUSSION Despite a high potential of VR in medical education, there are mandatory requirements for its integration into medical curricula addressing challenges related to finances, technical limitations, and didactic aspects. The reported lack of standardised and validated guidelines for evaluating VR training must be overcome to enable high-quality evidence for VR usage in medical education. Interdisciplinary teams of software developers, AI experts, designers, medical didactics experts and end users are required to design useful VR courses. Technical issues and compromised realism can be mitigated by further technological advancements.
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Affiliation(s)
- Marvin Mergen
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University, Building 9, Kirrberger Strasse 100, 66421, Homburg, Germany.
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University, Building 9, Kirrberger Strasse 100, 66421, Homburg, Germany
| | - Marcel Meyerheim
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Saarland University, Building 9, Kirrberger Strasse 100, 66421, Homburg, Germany
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Alt PS, Hamacher D, Anetzberger H, Becker R. Movement-based cognitive training does not significantly shorten the learning curve for acquiring arthroscopic basic skills. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38971975 DOI: 10.1002/ksa.12351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/04/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE Skilful arthroscopy requires an aboveaverage level of manual dexterity. It is evident that particular motor skills can be learned and trained before arthroscopic training. The aim of this prospective cohort study was to investigate the impact of movement-related cognitive training on the learning curve during arthroscopic basic training. METHODS Fifty right-handed participants without arthroscopic experience were matched to an intervention group (n = 25) and a control group (n = 25). Prior to basic arthroscopic skill training with a simulator, the intervention group underwent 12 weeks of movement-related cognitive training. Cognitive and motor skills were assessed in both groups by using standardised tests (CogniFit test, angle reproduction test, two-arm coordination test) as a pretest and, for the intervention group, again before arthroscopic training as a posttest. For arthroscopic simulator training, three tasks ('Telescoping', 'Periscoping', 'Triangulation') from the Fundamentals of Arthroscopic Surgery Training module were selected and practiced 10 times with the camera in the right and left hands. The learning progress was quantified by exercise time, camera path length and hook path length. RESULTS No significant differences in sex distribution, age distribution or the results of the pretests between the intervention group (n = 21) and the control group (n = 25) were found (n.s.). The intervention group improved significantly from the pretest to the posttest in the CogniFit (p = 0.003) and two-arm coordination test in terms of time (p < 0.001) and errors (p = 0.002) but not in the angle reproduction test. No significant differences were found between the groups for the three arthroscopic tasks. CONCLUSION The hypothesis that movement-related cognitive training shortens the learning curve for acquiring arthroscopic basic skills cannot be confirmed. Other factors influencing the learning curve such as talent, teaching method and motivation have a greater impact on the acquisition of complex motor skills. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Prisca S Alt
- Department of Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Dennis Hamacher
- Department of Health Sciences, European University of Applied Sciences (EUFH), Rostock, Germany
| | | | - Roland Becker
- Department of Orthopaedics & Traumatology, University Hospital Brandenburg, Brandenburg, Germany
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Feng L, Li W, Lai J, Yang W, Wu S, Liu J, Ma R, Lee S, Tian J. Validity of A Novel Simulator for Percutaneous Transforaminal Endoscopic Discectomy. World Neurosurg 2024; 187:e220-e232. [PMID: 38641247 DOI: 10.1016/j.wneu.2024.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Percutaneous transforaminal endoscopic discectomy (PTED) has steep learning curves and a high incidence of complications, but currently, efficient and economical training methods are lacking. This study aimed to validate a novel simulator for PTED. METHODS The simulated PTED included puncturing and establishing the working channel (PEWC) and endoscopic discectomy, with the PEWC being the tested module. Eleven experts and 21 novices were included and introduced to the simulator and tasks; all participants completed the PEWC. Outcomes included: total operation time, number of fluoroscopy for positioning the working sheath, number of spinal risk region invasion, Global Rating Scale (GRS) and a modified GRS, etc. The Mann-Whitney U test was used to compare 2 groups. Spearman's correlation coefficient analyzed continuous variables. RESULTS Experts outperformed novices in total operation time (P = 0.001), requiring fewer number of fluoroscopies for positioning the working sheath (P = 0.003). Additionally, experts had a lower number of spinal risk region invasions (P = 0.016) and higher scores on both the GRS (P < 0.001) and modified GRS (P < 0.001). PTED experience correlated with GRS scores (P = 0.001) and modified GRS (P < 0.001). The overall realism scored a median of 4 (3.75-5), and educational value had a median of 4 (range 3-5). CONCLUSIONS This study demonstrates the validity of the novel simulator, revealing significant associations between PTED experience and performance metrics in a simulated PEWC setting. Furthermore, the PEWC module also offers a good realistic design and high education value according to experts.
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Affiliation(s)
- Lei Feng
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jianming Lai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weihao Yang
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shangxing Wu
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiajia Liu
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ruixin Ma
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Soomin Lee
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Tian
- Clinical Skills Training Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Chuang H, Kuan F, Su W, Shih C, Chiang C, Ko P, Hong C, Chen Y, Hsu K. Evaluating effectiveness of cadaveric arthroscopic training for orthopaedic residents: A comparison of joints and training levels. J Exp Orthop 2024; 11:e12030. [PMID: 38774580 PMCID: PMC11106551 DOI: 10.1002/jeo2.12030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/19/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose This study aimed to evaluate the effects and interactions of training level and different joints on the outcomes of cadaveric arthroscopic training courses for orthopaedic residents. Methods This prospective study enrolled 16 orthopaedic residents who voluntarily participated in a cadaveric training programme involving the shoulder, elbow, wrist, knee and ankle joints. Outcomes were quantitatively assessed using task-specific checklists and the Arthroscopic Surgery Skill Evaluation Tool. Two-way analysis of variance (ANOVA) was conducted to determine the significance of the interactions between joint and years of training. Results Resident scores significantly increased after the dedicated lectures in all five joints (p = 0.003 for the shoulder module, p < 0.001 for the other joints). Two-way ANOVA revealed that the progress made after the dedicated lectures was significantly impacted by the joint (p = 0.006) and training level × joint interaction (p = 0.005) but not by the training level (p = 0.47). The simple effect of the joint was examined using Sidak's multiple comparison test. Among junior residents, the dedicated lectures resulted in more substantial progress in elbow and wrist arthroscopy when compared to shoulder arthroscopy (p = 0.020 and p = 0.043, respectively). Conclusions The results suggest that, in cadaveric arthroscopic training courses for orthopaedic residents, training outcomes are primarily impacted by the specific joint being trained rather than the training level. Specifically, junior residents demonstrated greater improvement with training in procedures that are less commonly encountered during on-the-job training, such as elbow and wrist arthroscopy. Clinical Relevance These findings suggest the need to prioritise wrist and elbow arthroscopic training for junior residents to optimise educational outcomes. Level of Evidence Level III.
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Affiliation(s)
- Hao‐Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Fa‐Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Biomedical EngineeringNational Cheng Kung UniversityTainanTaiwan
| | - Wei‐Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Skeleton Materials and Bio‐compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Musculoskeletal Research Center, Innovation HeadquartersNational Cheng Kung UniversityTainanTaiwan
| | - Chien‐An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Skeleton Materials and Bio‐compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Musculoskeletal Research Center, Innovation HeadquartersNational Cheng Kung UniversityTainanTaiwan
| | - Chen‐Hao Chiang
- Department of Biomedical EngineeringNational Cheng Kung UniversityTainanTaiwan
- Department of OrthopaedicsDitmanson Medical Foundation Chia‐Yi Christian HospitalChiayiTaiwan
| | - Po‐Yen Ko
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Skeleton Materials and Bio‐compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Musculoskeletal Research Center, Innovation HeadquartersNational Cheng Kung UniversityTainanTaiwan
| | - Chih‐Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Yueh Chen
- Skeleton Materials and Bio‐compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Musculoskeletal Research Center, Innovation HeadquartersNational Cheng Kung UniversityTainanTaiwan
- Department of OrthopedicsKaohsiung Veterans General Hospital Tainan BranchTainanTaiwan
| | - Kai‐Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Biomedical EngineeringNational Cheng Kung UniversityTainanTaiwan
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Li W, Ma S, Zhou L, Konge L, Pan J, Hui J. The bibliometric analysis of extended reality in surgical training: Global and Chinese perspective. Heliyon 2024; 10:e27340. [PMID: 38495188 PMCID: PMC10943385 DOI: 10.1016/j.heliyon.2024.e27340] [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: 07/02/2022] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives The prospect of extended reality (XR) being integrated with surgical training curriculum has attracted scholars. However, there is a lack of bibliometric analysis to help them better understand this field. Our aim is to analyze relevant literature focusing on development trajectory and research directions since the 21st century to provide valuable insights. Methods Papers were retrieved from the Web of Science Core Collection. Microsoft Excel, VOSviewer, and CiteSpace were used for bibliometric analysis. Results Of the 3337 papers published worldwide, China contributed 204, ranking fifth. The world's enthusiasm for this field has been growing since 2000, whereas China has been gradually entering since 2001. Although China had a late start, its growth has accelerated since around 2016 due to the reform of the medical postgraduate education system and the rapid development of Chinese information technology, despite no research explosive period has been yet noted. International institutions, notably the University of Toronto, worked closely with others, while Chinese institutions lacked of international and domestic cooperation. Sixteen stable cooperation clusters of international scholars were formed, while the collaboration between Chinese scholars was not yet stable. XR has been primarily applied in orthopedic surgery, cataract surgery, laparoscopic training and intraoperative use in neurosurgery worldwide. Conclusions There is strong enthusiasm and cooperation in the international research on the XR-based surgical training. Chinese scholars are making steady progress and have great potential in this area. There has not been noted an explosive research phase yet in the Chinese pace. The research on several surgical specialties has been summarized at the very first time. AR will gradually to be more involved and take important role of the research.
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Affiliation(s)
- Wei Li
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Ma
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Zhou
- School of Postgraduate Education, Southern Medical University, Guangzhou, China
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
- PENG CHENG Laboratory, Shenzhen, China
| | - Jialiang Hui
- Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou City, China
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Silvestre J, Ahn J, Mehta S, Harris MB. Impact of the SARS-CoV-2 outbreak on ACGME-accredited orthopaedic trauma fellowship training. Injury 2023; 54:111137. [PMID: 37919113 DOI: 10.1016/j.injury.2023.111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION The SARS-CoV-2 viral outbreak created unprecedented challenges in surgical education. Yet, its impact on reported case volume during orthopaedic trauma fellowship training remains poorly understood. We hypothesized that cases performed during orthopaedic trauma fellowship training would decrease by 8 %-17 % during the 2019-2020 academic year corresponding to the 1-2 month moratorium of non-essential cases during the initial SARS-CoV-2 outbreak in the United States. METHODS We designed a retrospective cohort study of orthopaedic trauma fellows at Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs (2018-2019 to 2021-2022). Mean case volumes were compared by case category across academic years. RESULTS There was a -13 % year-over-year decrease in reported case volume during the 2019-2020 academic year (505 ± 126 vs 441 ± 94, P = 0.079, Fig. 1). Case categories with the greatest percentage declines were Treatment of Nonunion / Malunion (-31 %), Fasciotomy (-25 %), External Fixation (-21 %), Forearm / Wrist (-21 %), and Intra-articular Distal Humerus Fracture (-17 %). There was a 7 % year-over-year increase in case volume during the subsequent 2020-2021 academic year with near universal increases in case volume across case categories. CONCLUSION There was a 13 % decrease in orthopaedic trauma case volume during the 2019-2020 academic year, corresponding to the SARS-CoV-2 outbreak. Certain trauma case categories experienced the greatest negative impact, which subsequently recovered during the next academic year. These results may help inform accrediting bodies and surgical educators on the impact of future viral outbreaks on orthopaedic trauma fellowship training.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, SC, United States.
| | - Jaimo Ahn
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Samir Mehta
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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Guerra Bresson H, Baumann Q, El Koussaify J, Benayoun M, Maillot C, Rousseau MA, Boyer P. Arthroscopic approach in initial training: Study of a novice cohort using inverse direct and indirect approaches and its implication in the development of training programs. Orthop Traumatol Surg Res 2023; 109:103552. [PMID: 36649789 DOI: 10.1016/j.otsr.2023.103552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 11/08/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Arthroscopic training includes successive stages of observation, reproduction and then repetition. Learning through simulation in 2D virtual reality makes it possible to repeat these different stages to enhance the learner's experience in complete safety and a shorter timeframe. Some procedures require inversion of the optical and instrumental approaches in the axial plane, disrupting the existing psychomotor and technical skills. The objective of this study was to compare the degree of difficulty and the distribution of results for the same exercise carried out alternately in classical holding and inverted holding of the instruments in a cohort of novice learners. MATERIALS AND METHODS Twenty-two medical students, novices in arthroscopic surgery, participated in the study. Each performed an exercise consisting of grasping ten targets with arthroscopic forceps and placing them in a basket on the VirtaMed ArthroS™ simulator. The exercise was performed with the scope and grasping instrument pointed away from the operator, "catch the stars front" (CTSF), then directed towards the operator, "catch the stars back" (CTSB). The simulator recorded several parameters making up an overall composite score ("overall performance score", OPS) out of 120 points. Voluntary abandonment of the exercise was also collected. RESULTS All students completed the CTSF exercise but 6 dropped out of the CTSB exercise (27%, p=0.01). In the CTSF exercise, the average OPS was higher with 45.9 points versus 22.8 points in the CTSB exercise (p<0.001). By detailing the components of the OPS score, the parameters of interest on the Fundamentals of Arthroscopic Training (FAST) module of the simulator included: the distance traveled by the scope and the grasping forceps was significantly greater in the CTSB group (p<0.001), the duration of the exercise was significantly greater in the CTSB group (p<0.001), the time spent with the instruments in the videoscopic field was significantly lower in the CTSB group (p=0.001) and finally the absence of a significant difference in the camera alignment compared to the horizontal plane between the two groups. CONCLUSION The exercise with the instruments directed towards the operator is more difficult with a greater distribution for all the secondary criteria except for the camera alignment, which suggests that it could be more discriminating. The dropout rate is also higher. It would therefore be interesting to introduce CTSB type training in initial training programs in arthroscopy. LEVEL OF EVIDENCE III, comparative prospective study.
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Affiliation(s)
- Héléna Guerra Bresson
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France.
| | - Quentin Baumann
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Jad El Koussaify
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Marie Benayoun
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Cédric Maillot
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Marc-Antoine Rousseau
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Patrick Boyer
- Service de chirurgie orthopedique et traumatologique, Hôpital Bichat - Claude-Bernard, Paris, France
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Brennan JN, Hall AJ, Baird EJ. Online case-based educational meetings can increase knowledge, skills, and widen access to surgical training:The nationwideVirtualTrauma & Orthopaedic Meetingseries. Surgeon 2023; 21:e263-e270. [PMID: 36914519 DOI: 10.1016/j.surge.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Access to surgical training is challenging for undergraduate and early postgraduate trainees due to a greater focus on developing generic knowledge and skills, and a drive to recruit greater numbers into internal medicine and primary care. COVID-19 accelerated the declining access to surgical training environments. Our aims were to: 1) establish the feasibility of an online, specialty-specific, case-based surgical training series, and 2) evaluate its suitability for meeting the needs of trainees. METHODS A nationwide audience of undergraduate and early postgraduate trainees were invited to a series of bespoke online case-based educational meetings in Trauma & Orthopaedics (T&O) over a six month period. The six sessions, which simulated real-world clinical meetings, were constructed by Consultant sub-specialists and involved the presentation of cases by registrars, followed by structured discussion of basic principles, radiological interpretation, and management strategies. Mixed qualitative and quantitative analyses were conducted. RESULTS There were 131 participants (59.5% male), consisting mostly of doctors in training (58%) and medical students (37.4%). The mean quality rating was 9.0/10 (SD 1.06), further supported by qualitative analysis. 98% enjoyed the sessions, 97% reported improved knowledge of T&O, and 94% reported a direct benefit to clinical practice. There was a significant improvement in knowledge of T&O conditions, management plans, and radiological interpretation (p = <0.05). CONCLUSION Structured virtual meetings, underpinned by bespoke clinical cases, may widen access to T&O training, increase flexibility and robustness of learning opportunities, and mitigate the effects of reduced exposure on preparation for surgical careers and recruitment.
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Affiliation(s)
- Joseph N Brennan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew J Hall
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Edinburgh, Edinburgh, UK.
| | - Emily J Baird
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; Royal Hospital for Children & Young People, Edinburgh, UK
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Lamb A, McKinney B, Frousiakis P, Diaz G, Sweet S. A Comparative Study of Traditional Technique Guide versus Virtual Reality in Orthopedic Trauma Training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:947-955. [PMID: 37693298 PMCID: PMC10487700 DOI: 10.2147/amep.s395087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/20/2023] [Indexed: 09/12/2023]
Abstract
Background Medical and surgical education is an expansive field fraught with many challenges. Technology such as virtual reality could be a new venue that can offer a solution to improve surgical training. Objective The objective of this prospective, blinded study was to evaluate virtual reality as a training model for orthopedic surgery and surgical training at large. Methods Fourth-year medical students with novice skills volunteered to participate in this observer-blinded 1:1 randomized controlled trial. They had no prior experience in tibia intramedullary nail (IMN) surgery. They were randomized into traditional technique guide education and virtual reality. The participants were timed on their mock surgery, and a blinded observer was utilized to subjectively grade their performance throughout the procedure using the Global Assessment 5-point Rating Scale and Procedure-Specific Checklist. Results Thirty-eight participants were recruited and randomized into virtual reality (19) and traditional (19) groups. There were trends in all categories favoring the virtual reality group. The VR group had improved time to completion (9.6 minutes vs 12.2 minutes, P = 0.034) and reduced need for corrections within the mock procedure (2.2 vs 2.5; P = 0.05). Conclusion Virtual reality training was more effective than traditional training in learning and completing the steps of the tibia IMN surgery for novice medical students. Virtual reality training may be a useful method to augment orthopedic education and surgical training.
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Affiliation(s)
- Ashley Lamb
- Orthopedic Surgery, Community Memorial Hospital, Ventura, CA, USA
| | - Brandon McKinney
- Orthopedic Surgery, Community Memorial Hospital, Ventura, CA, USA
| | | | - Graal Diaz
- Research Department-Graduate Medical Education, Community Memorial Healthcare System, Ventura, CA, USA
| | - Stephan Sweet
- Orthopedic Surgery, Community Memorial Hospital, Ventura, CA, USA
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James HK, Griffin DR, Griffin J, Fisher JD, Pattison GTR. Ankle fracture internal fixation performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary, multicentre randomized controlled trial. Bone Jt Open 2023; 4:594-601. [PMID: 37586708 PMCID: PMC10546066 DOI: 10.1302/2633-1462.48.bjo-2022-0144.r1] [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] [Indexed: 08/18/2023] Open
Abstract
Aims Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. Methods We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard training. Primary outcome was fracture reduction on postoperative radiographs. Results Overall, 139 ankle fractures were fixed by 28 postgraduate year three to five trainee surgeons (mean age 29.4 years; 71% males) during ten months' follow-up. Under the intention-to-treat principle, a technically superior fixation was performed by the cadaveric-trained group compared to the standard-trained group, as measured on the first postoperative radiograph against predefined acceptability thresholds. The cadaveric-trained group used a lower intraoperative dose of radiation than the standard-trained group (mean difference 0.011 Gym2, 95% confidence interval 0.003 to 0.019; p = 0.009). There was no difference in procedure time. Conclusion Trainees randomized to cadaveric training performed better ankle fracture fixations and irradiated patients less during surgery compared to standard-trained trainees. This effect, which was previously unknown, is likely to be a consequence of the intervention. Further study is required.
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Affiliation(s)
- Hannah K. James
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Damian R. Griffin
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Joanne D. Fisher
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Giles T. R. Pattison
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
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12
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Sienko A, Ekhtiari S, Khanduja V. The growth of hip preservation as a speciality. Knee Surg Sports Traumatol Arthrosc 2023; 31:2540-2543. [PMID: 37045973 DOI: 10.1007/s00167-023-07409-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Anna Sienko
- University of Cambridge, Clinical School of Medicine, Cambridge, UK
| | - Seper Ekhtiari
- Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Hills Road, Box 37, Cambridge, CB2 0QQ, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Hills Road, Box 37, Cambridge, CB2 0QQ, UK.
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13
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Crockatt WK, Confino JE, Kopydlowski NJ, Jobin CM, Levine WN. Comparing Skill Acquisition and Validity of Immersive Virtual Reality with Cadaver Laboratory Sessions in Training for Reverse Total Shoulder Arthroplasty. JB JS Open Access 2023; 8:e22.00141. [PMID: 37415724 PMCID: PMC10319363 DOI: 10.2106/jbjs.oa.22.00141] [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: 07/08/2023] Open
Abstract
Immersive virtual reality (iVR) allows surgical trainees to practice skills without risking harm to patients or the need for cadaveric training resources. However, iVR has never been directly compared with cadaver training, the longtime gold standard for surgical skill training. We aimed to compare skill acquisition using cadaver laboratory and iVR training methods for augmented baseplate implantation during reverse total shoulder arthroplasty (rTSA). Methods In a randomized controlled trial, junior orthopaedic surgery residents were assigned to a 1-hour training with either iVR or a cadaveric laboratory session with shoulder specimens. Before training, all participants viewed an overview lecture and technique video demonstrating key steps of augmented baseplate implantation for rTSA. Participants were assessed by a blinded evaluator using validated competency checklists during cadaveric glenoid baseplate implantation. Continuous and categorial variables were analyzed using the 2-sample t test and Fisher exact test. Results Fourteen junior residents (3 incoming matched postgraduate year [PGY1], 6 PGY1s, 1 PGY2, and 4 PGY3s) were randomized to training with either iVR (n = 6) or cadaver laboratory (n = 8). There were no significant differences in demographic data, previous experience with rTSA, or previous use of iVR (p > 0.05). There were no significant difference in total Objective Structured Assessment of Technical Skill score (91.2% [15.2] vs. 93.25% [6.32], -0.1406 to 0.1823, p = 0.763), Global Rating Scale score (4.708 [0.459] vs. 4.609 [0.465], -0.647 to 0.450, p = 0.699), or time to completion (546 seconds [158] vs. 591 seconds [192], -176.3 to 266.8, p = 0.655) in cadaveric glenoid baseplate implantation. Average cost of iVR hardware and a 1-year software license was $4,900, and average cost of a single cadaver laboratory was $1,268.20 per resident. Conclusions Among junior orthopaedic residents, there is similar skill acquisition when training with either cadaver laboratory or iVR. Although additional research into this field is needed, iVR may provide an important and cost-effective tool in surgical education. Clinical Relevance Emerging simulation and iVR technology simulation in surgical training programs can increase access to effective and high-level surgical training across the globe and improve quality of care.
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Affiliation(s)
- William K. Crockatt
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Jamie E. Confino
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Nathan J. Kopydlowski
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Charles M. Jobin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - William N. Levine
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
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14
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Morscheid YP, Pouessel F. [Simulators and other tools in orthopedic-trauma surgery training]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04394-2. [PMID: 37286622 DOI: 10.1007/s00132-023-04394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The classic paradigm of "learning on the patient in the operating room" is more and more in conflict with the growing requirements of cost-efficient work and patient safety. With the technology available today for simulator systems, the accessibility of digital tools and the development of a metaverse as a digital meeting place result in various application scenarios and alternatives to classic orthopedic training. SIMULATORS First VR-desktop simulations in orthopedics and traumatology were developed more than 20 years ago. VR-desktop simulators consist of a computer with a video screen and a joint model. Different instruments can be paired with this system and allow haptic feedback. With innovative software, numerous training programs can be selected, and the user receives precise feedback on their performance. Immersive VR simulators have also played an increasingly important role in recent years. OTHER DIGITAL TOOLS The use of digital media such as audio and video podcasts as learning and information sources increased in the context of COVID-19. There is also an increasing number of orthopedic and trauma surgery topics on social media platforms. In all fields, however, there is a risk of the spread of misinformation. A quality standard must be maintained. EFFECTIVENESS AND UTILITY OF THE TRAINING In order to evaluate simulators and their value as a training tool, it is important to comply with various validity criteria. Transfer validity plays an essential role for clinical application. Various studies demonstrate that the skills learned on simulators can also be successfully transferred to real clinical scenarios. DISCUSSION A lack of availability, costs and high effort are limitations of classic training methods. In contrast, there are versatile use cases of VR-based simulations that are individually adapted to the trainees and cannot endanger patients. The still high acquisition costs, technical obstacles and the not yet widespread availability are limiting factors. The metaverse still offers unimaginable possibilities today to transfer VR-based applications to experimental learning methods.
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Affiliation(s)
- Yannik P Morscheid
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Gebäude 37-38, 66421, Homburg, Deutschland.
| | - Florian Pouessel
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Gebäude 37-38, 66421, Homburg, Deutschland
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15
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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: 12] [Impact Index Per Article: 12.0] [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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17
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Zhang J, Lu V, Khanduja V. The impact of extended reality on surgery: a scoping review. INTERNATIONAL ORTHOPAEDICS 2023; 47:611-621. [PMID: 36645474 PMCID: PMC9841146 DOI: 10.1007/s00264-022-05663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Extended reality (XR) is defined as a spectrum of technologies that range from purely virtual environments to enhanced real-world environments. In the past two decades, XR-assisted surgery has seen an increase in its use and also in research and development. This scoping review aims to map out the historical trends in these technologies and their future prospects, with an emphasis on the reported outcomes and ethical considerations on the use of these technologies. METHODS A systematic search of PubMed, Scopus, and Embase for literature related to XR-assisted surgery and telesurgery was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies, peer-reviewed articles that described procedures performed by surgeons on human subjects and cadavers, as well as studies describing general surgical education, were included. Non-surgical procedures, bedside procedures, veterinary procedures, procedures performed by medical students, and review articles were excluded. Studies were classified into the following categories: impact on surgery (pre-operative planning and intra-operative navigation/guidance), impact on the patient (pain and anxiety), and impact on the surgeon (surgical training and surgeon confidence). RESULTS One hundred and sixty-eight studies were included for analysis. Thirty-one studies investigated the use of XR for pre-operative planning concluded that virtual reality (VR) enhanced the surgeon's spatial awareness of important anatomical landmarks. This leads to shorter operating sessions and decreases surgical insult. Forty-nine studies explored the use of XR for intra-operative planning. They noted that augmented reality (AR) headsets highlight key landmarks, as well as important structures to avoid, which lowers the chance of accidental surgical trauma. Eleven studies investigated patients' pain and noted that VR is able to generate a meditative state. This is beneficial for patients, as it reduces the need for analgesics. Ten studies commented on patient anxiety, suggesting that VR is unsuccessful at altering patients' physiological parameters such as mean arterial blood pressure or cortisol levels. Sixty studies investigated surgical training whilst seven studies suggested that the use of XR-assisted technology increased surgeon confidence. CONCLUSION The growth of XR-assisted surgery is driven by advances in hardware and software. Whilst augmented virtuality and mixed reality are underexplored, the use of VR is growing especially in the fields of surgical training and pre-operative planning. Real-time intra-operative guidance is key for surgical precision, which is being supplemented with AR technology. XR-assisted surgery is likely to undertake a greater role in the near future, given the effect of COVID-19 limiting physical presence and the increasing complexity of surgical procedures.
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Affiliation(s)
- James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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Mank VMF, Arter Z, Mank J, Eum KS, Roberts J. Improving Self-Confidence of Military Medical Providers With Joint Procedure Simulation: A Pilot Study. Mil Med 2023; 188:e382-e387. [PMID: 34318332 DOI: 10.1093/milmed/usab319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/09/2021] [Accepted: 07/14/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Military medical providers are a unique population that encounter different environments across the world. From hospital clinics to war zones, these providers must perform procedures and rely on their training and skill to help their patients. This pilot study aimed to assess the self-confidence of military medical providers performing joint aspiration and injection before and after a simulation workshop in both clinical and austere settings. METHODS In 2016, 25 military physicians from various military facilities participated in a 1-hour knee arthrocentesis and injection and shoulder injection workshop. Education was provided on the knee and shoulder anatomy and various approaches to performing the procedures before the hands-on portion of the workshop. Surveys assessing self-reported confidence levels by performing the procedures in the clinic and austere settings were completed before and after simulation training. RESULTS The results were analyzed and grouped based on the provider experience level, simulation environment, and specific procedure performed. There was a statistical significance seen in the shoulder arthrocentesis group, which included all participating providers, with a P-value of <.01 in the clinic setting and a P-value of <.001 in the austere setting. In the knee aspiration simulation, there were also improvements in the provider confidence, but it was not statistically significant with P-values of .36 and .14 in the clinical and austere settings, respectively. CONCLUSION Simulation training can lead to increased medical provider self-confidence in performing musculoskeletal joint aspirations and injections in both clinic and austere settings. The military medicine demographics have had little research in joint injections and provider confidence to date. This pilot study was one of the first to evaluate this unique population. The methods used in this study, and the positive data collected on provider confidence, can be used in larger studies, encompassing other medical providers to increase the confidence of providers throughout various fields of medicine.
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Affiliation(s)
- Victoria M F Mank
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Zhaohui Arter
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Jeffrey Mank
- University of New England, Biddeford, ME 04005, USA
| | - Ki Suk Eum
- Division of Rheumatology, Scripps Green Hospital, La Jolla, CA 92037, USA
| | - Jefferson Roberts
- Department of Rheumatology, Tripler Army Medical Center, Honolulu, HI 96859, USA
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A virtual surgical prototype system based on gesture recognition for virtual surgical training in maxillofacial surgery. Int J Comput Assist Radiol Surg 2022; 18:909-919. [PMID: 36418763 PMCID: PMC10113313 DOI: 10.1007/s11548-022-02790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Virtual reality (VR) technology is an ideal alternative of operation training and surgical teaching. However, virtual surgery is usually carried out using the mouse or data gloves, which affects the authenticity of virtual operation. A virtual surgery system with gesture recognition and real-time image feedback was explored to realize more authentic immersion.
Method
Gesture recognition technology proposed with an efficient and real-time algorithm and high fidelity was explored. The recognition of hand contour, palm and fingertip was firstly realized by hand data extraction. Then, an Support Vector Machine classifier was utilized to classify and recognize common gestures after extraction of feature recognition. The algorithm of collision detection adopted Axis Aligned Bounding Box binary tree to build hand and scalpel collision models. What’s more, nominal radius theorem (NRT) and separating axis theorem (SAT) were applied for speeding up collision detection. Based on the maxillofacial virtual surgical system we proposed before, the feasibility of integration of the above technologies in this prototype system was evaluated.
Results
Ten kinds of signal static gestures were designed to test gesture recognition algorithms. The accuracy of gestures recognition is more than 80%, some of which were over 90%. The generation speed of collision detection model met the software requirements with the method of NRT and SAT. The response time of gesture] recognition was less than 40 ms, namely the speed of hand gesture recognition system was greater than 25 Hz. On the condition of integration of hand gesture recognition, typical virtual surgical procedures including grabbing a scalpel, puncture site selection, virtual puncture operation and incision were carried out with realization of real-time image feedback.
Conclusion
Based on the previous maxillofacial virtual surgical system that consisted of VR, triangular mesh collision detection and maxillofacial biomechanical model construction, the integration of hand gesture recognition was a feasible method to improve the interactivity and immersion of virtual surgical operation training.
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McKinney B, Dbeis A, Lamb A, Frousiakis P, Sweet S. Virtual Reality Training in Unicompartmental Knee Arthroplasty: A Randomized, Blinded Trial. JOURNAL OF SURGICAL EDUCATION 2022; 79:1526-1535. [PMID: 35863958 DOI: 10.1016/j.jsurg.2022.06.008] [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: 11/17/2021] [Revised: 02/09/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of immersive virtual reality training in orthopedic surgery education in comparison to the standard technique guide for fixed-bearing medial unicompartmental knee arthroplasty DESIGN: Participants included 22 orthopedic surgery residents who were randomized to undergo fixed-bearing medial unicompartmental knee arthroplasty (UKA) surgical training with either an immersive virtual reality technology or by studying the traditional technique guide. Participants were randomized within their training year via block randomization. Participants then performed a medial UKA on a SawBone model using standard industry system surgical trays and equipment. Proficiency, timing, number of errors made, and subjective data were obtained during and after the SawBone procedure. A blinded observer was utilized to obtain objective data. SETTING Community Memorial Health System, a primary clinical care institution in Ventura, California. PARTICIPANTS Twenty-two orthopedic surgery residents were randomly selected. There were 7 PGY-1 residents (3 TG, 4 VR), 7 PGY-2s (4 TG, 3 VR), 3 PGY-3s (1 TG, 2 VR), 3 PGY-4s (2 TG, 1 VR), and 2 PGY-5s (1 TG, 1 VR) in total. Eligibility criteria were 1) an active orthopedic surgery resident, 2) no prior immersive VR surgical training, and 3) no prior experience with the Zimmer PPK implants or its technique guide. All participants completed the study. RESULTS Residents were randomized evenly in the virtual reality (n = 11) and technique guide groups (n = 11). Analysis showed that residents who trained with the immersive VR executed significantly more steps correctly (33 vs. 27, p < 0.01) and completed their procedure in significantly faster time (26.7 vs. 35.4 minutes, p < 0.01). They also scored higher in all global assessment categories reaching significance in 4 of 5 categories. Subjective questionnaire responses demonstrated positive feedback within both groups with a trend toward virtual reality. No adverse events were recorded. CONCLUSIONS Immersive virtual reality was more effective than traditional training for the participants of this study. There are numerous potential applications of this technology and it provides an alternative learning modality to accommodate different learning styles.
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Affiliation(s)
- Brandon McKinney
- Orthopedic Surgery Resident, Graduate Medical Education, Community Memorial Hospital, Ventura, California
| | - Ammer Dbeis
- Orthopedic Surgery Resident, Graduate Medical Department, Community Memorial Hospital, Ventura, California.
| | - Ashley Lamb
- Orthopedic Surgery Trauma Fellow, Department of Orthopedic Surgery, University of Southern California, Los Angeles, California
| | - Petros Frousiakis
- Orthopedic Surgery Faculty, Department of Orthopedic Surgery, Community Memorial Hospital, Los Angeles, California
| | - Stephan Sweet
- Orthopedic Surgery Faculty, Department of Orthopedic Surgery, Community Memorial Hospital, Los Angeles, California
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Mandal P, Ambade R. Surgery Training and Simulation Using Virtual and Augmented Reality for Knee Arthroplasty. Cureus 2022; 14:e28823. [PMID: 36225417 PMCID: PMC9535617 DOI: 10.7759/cureus.28823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022] Open
Abstract
A range of extended reality technology integration, including immersive virtual reality (IVR), augmented reality (AR), as well as mixed reality, has lately acquired favour in orthopaedics. The utilization of extended reality machinery in knee arthroplasty is examined in this review study. Virtual reality (VR) and AR are usually exercised together in orthopaedic surgical training as alluring training outside of the operation theatre is acknowledged as a good surgical training tool. The use of this technology, its consequences for orthopaedic surgeons and their patients, and its moral and practical issues are also covered. Head-mounted displays (HMDs) are a potential addition directed toward improving surgical precision along with instruction. Although the hardware is cutting-edge, substantial effort needs to be done to develop software that enables seamless, trustworthy integration into clinical practice and training. Remote virtual rehabilitation has drawn increasing attention in recent years, and its significance has increased in light of the recent outbreak of the COVID-19 epidemic. Numerous medical sectors have shown the benefits of telerehabilitation, gamification, VR, and AR. Given the rising demand for orthopaedic therapy and its rising costs, this is a requirement. A remote surgeon can impart knowledge without being present, by virtually placing his or her hands in the visual field of a local surgeon using AR technology. With the use of this innovation, orthopaedic surgery seems to have been able to participate in the telemedicine revolution. This technology may also have an impact on how surgeons collaborate and train for orthopaedic residencies in the future. Volatility in the HMD market will probably stall improvements in surgical education.
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Establishment of a combat damage control surgery training platform for explosive combined thoraco-abdominal injuries. Chin J Traumatol 2022; 25:193-200. [PMID: 35331606 PMCID: PMC9252934 DOI: 10.1016/j.cjtee.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries. METHODS The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results. RESULTS The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training. CONCLUSION The platform established in this study was useful for CDCS training.
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Iyengar KP, Zaw Pe E, Jalli J, Shashidhara MK, Jain VK, Vaish A, Vaishya R. Industry 5.0 technology capabilities in Trauma and Orthopaedics. J Orthop 2022; 32:125-132. [DOI: 10.1016/j.jor.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 12/29/2022] Open
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Hall AJ, Walmsley P. Technology-enhanced learning in orthopaedics: Virtual reality and multi-modality educational workshops may be effective in the training of surgeons and operating department staff. Surgeon 2022:S1479-666X(22)00077-4. [PMID: 35624020 DOI: 10.1016/j.surge.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
AIM The aims were to assess the utility of: 1) virtual reality-mediated simulation, and 2) a multi-modality 'Bootcamp' in the delivery of total knee arthroplasty (TKA) teaching to orthopaedic surgical trainees. BACKGROUND Surgical training opportunities are diminished as a result of the COVID-19 pandemic which may result in delays to training completion and gaps in the permanent workforce. Modern and technology-enhanced learning methods have been identified as having the potential to support high-quality and sustainable education. METHODS This mixed-methods study assessed the educational benefit of two activities designed to teach TKA to junior (ST1-3) orthopaedic trainees. A multi-modality training Bootcamp was delivered that included: virtual reality (VR) and saw-bone simulation; tutorials, and case-based symposia. The VR component was delivered to different participants (surgical trainees, scrub nurses, and consultants) on a further two separate occasions. Qualitative and quantitative data were collected pertaining to utility and performance. RESULTS Trainees reported that the Bootcamp improved comprehension of arthroplasty principles including component alignment, knee balancing, and intraoperative strategies. Case-based discussions helped develop diagnostic and decision-making skills. The VR activity improved understanding of the surgical process map, increased ability to anticipate steps, and consider the procedure strategically. All staff groups found the VR activity beneficial and would recommend it as a useful addition to a surgical department. CONCLUSION VR-mediated simulation could augment the education of surgical trainees and scrub team staff by improving comprehension of the surgical process map. Integrated multi-modality 'Bootcamp-style' training activities constructed around trainees' needs may provide a sustainable solution to bridge the experience gap related to reduced exposure to elective orthopaedic practice.
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Affiliation(s)
- Andrew J Hall
- Chief Resident & Research Fellow, Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK; MBChB Module Organiser, Department of Orthopaedics & Trauma, University of Edinburgh, UK; Clinical Teaching Fellow, Medical Education Directorate, NHS Lothian, UK.
| | - Phil Walmsley
- Consultant Orthopaedic Surgeon, Department of Trauma & Orthopaedics, NHS Fife, UK; Honorary Senior Lecturer, University of St Andrews Medical School, UK; Associate Postgraduate Dean (Quality), NHS Education for Scotland, UK.
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Batailler C, Shatrov J, Sappey-Marinier E, Servien E, Parratte S, Lustig S. Artificial intelligence in knee arthroplasty: current concept of the available clinical applications. ARTHROPLASTY 2022; 4:17. [PMID: 35491420 PMCID: PMC9059406 DOI: 10.1186/s42836-022-00119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Artificial intelligence (AI) is defined as the study of algorithms that allow machines to reason and perform cognitive functions such as problem-solving, objects, images, word recognition, and decision-making. This study aimed to review the published articles and the comprehensive clinical relevance of AI-based tools used before, during, and after knee arthroplasty. Methods The search was conducted through PubMed, EMBASE, and MEDLINE databases from 2000 to 2021 using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA). Results A total of 731 potential articles were reviewed, and 132 were included based on the inclusion criteria and exclusion criteria. Some steps of the knee arthroplasty procedure were assisted and improved by using AI-based tools. Before surgery, machine learning was used to aid surgeons in optimizing decision-making. During surgery, the robotic-assisted systems improved the accuracy of knee alignment, implant positioning, and ligamentous balance. After surgery, remote patient monitoring platforms helped to capture patients’ functional data. Conclusion In knee arthroplasty, the AI-based tools improve the decision-making process, surgical planning, accuracy, and repeatability of surgical procedures.
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Evaluation of a Slipped Capital Femoral Epiphysis Virtual Reality Surgical Simulation for the Orthopaedic Trainee. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00020. [PMID: 35467580 PMCID: PMC9042586 DOI: 10.5435/jaaosglobal-d-22-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to compare outcomes between orthopaedic trainees using various preoperative training platforms (physical simulation [PS], virtual reality [VR], and reading/videos) in a slipped capital femoral epiphysis model.
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Ten hours of simulator training in arthroscopy are insufficient to reach the target level based on the Diagnostic Arthroscopic Skill Score. Knee Surg Sports Traumatol Arthrosc 2022; 30:1471-1479. [PMID: 34189609 DOI: 10.1007/s00167-021-06648-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Simulator arthroscopy training has gained popularity in recent years. However, it remains unclear what level of competency surgeons may achieve in what time frame using virtual training. It was hypothesized that 10 h of training would be sufficient to reach the target level defined by experts based on the Diagnostic Arthroscopic Skill Score (DASS). METHODS The training concept was developed by ten instructors affiliated with the German-speaking Society of Arthroscopy and Joint Surgery (AGA). The programme teaches the basics of performing arthroscopy; the main focus is on learning and practicing manual skills using a simulator. The training was based on a structured programme of exercises designed to help users reach defined learning goals. Initially, camera posture, horizon adjustment and control of the direction of view were taught in a virtual room. Based on these skills, further training was performed with a knee model. The learning progress was assessed by quantifying the exercise time, camera path length and instrument path length for selected tasks. At the end of the course, the learners' performance in diagnostic arthroscopy was evaluated using DASS. Participants were classified as novice or competent based on the number of arthroscopies performed prior to the assessment. RESULTS Except for one surgeon, 131 orthopaedic residents and surgeons (29 women, 102 men) who participated in the seven courses agreed to anonymous data analysis. Fifty-eight of them were competents with more than ten independently performed arthroscopies, and 73 were novices, with fewer than ten independently performed arthroscopies. There were significant reductions in exercise time, camera path length and instrument path length for all participants after the training, indicating a rapid increase in performance. No difference in camera handling between the dominant and non-dominant sides was found in either group. The competents performed better than the novices in various tasks and achieved significantly better DASS values on the final performance test. CONCLUSIONS Our data have demonstrated that arthroscopic skills can be taught effectively on a simulator, but a 10-h course is not sufficient to reach the target level set by experienced arthroscopists. However, learning progress can be monitored more objectively during simulator training than in the operating room, and simulation may partially replace the current practice of arthroscopic training. LEVEL OF EVIDENCE III.
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Vaghela KR, Trockels A, Lee J, Akhtar K. Is the Virtual Reality Fundamentals of Arthroscopic Surgery Training Program a Valid Platform for Resident Arthroscopy Training? Clin Orthop Relat Res 2022; 480:807-815. [PMID: 34939955 PMCID: PMC8923590 DOI: 10.1097/corr.0000000000002064] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/04/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Training in arthroscopy is associated with a steep learning curve for trainees and bears risks for patients. Virtual reality (VR) arthroscopy simulation platforms seek to overcome this and to provide a safe environment for surgical learners. The Fundamentals of Arthroscopic Surgery Training (FAST) program is one such platform. It is currently not known whether the VR FAST program can be employed as a useful teaching or examination tool to assess the basic arthroscopic skills of surgical trainees. QUESTIONS/PURPOSES (1) Does the VR FAST program differentiate among novice, intermediate, and expert arthroscopists? (2) Does ambidextrous performance in the VR FAST program correlate with arthroscopic experience? METHODS We prospectively recruited orthopaedic interns (novices), residents (intermediates), and fellows and attendings (experts) to complete the VR FAST program over a 1-year period from four major orthopaedic training programs on a voluntary basis. Sixty-six of 156 invited orthopaedic surgeons participated: 26 of 50 novices (16 men and 10 women), 27 of 65 intermediates (20 men and seven women), and 13 of 41 experts (10 men and three women). Surgeons of any arthroscopic experience were included, with only those with prior experience on the VR FAST program being excluded. The program consists of eight modules: three basic camera modules (Image Centering, Horizon Control, and Telescoping), three advanced camera modules (Periscoping, Trace the Line, and Trace the Curve), and two instrumented bimanual-dexterity modules (Probe Triangulation and Gather the Stars). Time taken to complete each task and measures of economy of movement (camera and instrument path length, camera alignment) were used as measures of arthroscopic experience. Every participant completed the modules using their dominant and nondominant hands. Equality in proficiency in completing the tasks using the dominant and nondominant hands were determined to be measures of arthroscopic experience. Due to the large number of outcome variables, only p values < 0.01 were considered to be statistically significant. RESULTS Six of eight VR FAST modules did not discriminate among novice, intermediate, and expert arthroscopy participants. However, two did, and the ones that were most effective at distinguishing participants by level of experience were the Periscoping and Gather the Stars modules. For the Periscoping module using the dominant hand, novices required longer to complete the task with a median time of 231 seconds (IQR 149 to 358) and longer camera path length median of 191 cm (IQR 128 to 273) compared with intermediates who needed 127 seconds (IQR 106 to 233) and 125 cm (IQR 92 to 159) and experts who needed 121 seconds (IQR 93 to 157) and 119 cm (IQR 90 to 134) (p = 0.001 and p = 0.003, respectively). When using the nondominant hand, novices took longer to complete the task with a median time of 231 seconds (IQR 170 to 350) and longer camera path length 204 cm (IQR 169 to 273) compared with intermediates who required 132 seconds (IQR 97 to 162) and 111 cm (IQR 88 to 143) and experts who needed 119 seconds (IQR 104 to 183) and 120 cm (IQR 108 to 166) (p < 0.001 and p < 0.001, respectively). For the Gather the Stars module using the nondominant hand, only the novices needed longer to complete the task at a median of 131 seconds (IQR 112 to 157) and needed a longer grasper path length of 290 cm (IQR 254 to 332) compared with intermediates who needed 84 seconds (IQR 72 to 119) and 232 cm (IQR 195 to 254) and experts who needed 98 seconds (IQR 87 to 107) and 244 cm (IQR 215 to 287) (p < 0.001 and p = 0.001, respectively). CONCLUSION Six of eight VR FAST modules did not demonstrate construct validity, and we found no correlation between arthroscopic experience and ambidextrous performance. Two modules demonstrated construct validity; however, refinement and expansion of the modules is needed with further validation in large prospective trials so that pass-fail thresholds can be set for use in high-stakes examinations. CLINICAL RELEVANCE Most VR FAST modules were not discriminatory; however, they can form essential conceptual and procedural building blocks in an arthroscopic curriculum that are beneficial for novices when developing key psychomotor skills. In their present format, however, they are unsuitable for assessing arthroscopic proficiency.
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Affiliation(s)
- Kalpesh R. Vaghela
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Amaury Trockels
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Joshua Lee
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Kash Akhtar
- Department of Trauma & Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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Abstract
Total hip arthroplasty is one of the most common and successful orthopedic surgeries. Sometimes, periprosthetic osteolysis occurs associated with the stress-shielding effect: it results in the reduction of bone density, where the femur is not correctly loaded, and in the formation of denser bone, where stresses are confined. This paper illustrates the stress shielding effect as a cause of the failing replacement of the hip joint. An extensive literature survey has been accomplished to describe the phenomenon and identify solutions. The latter refer to the design criteria and the choice of innovative materials/treatments for prosthetic device production. Experimental studies and numerical simulations have been reviewed. The paper includes an introduction to explain the scope; a section illustrating the causes of the stress shielding effect; a section focusing on recent attempts to redefine prosthetic device design criteria, current strategies to improve the osteointegration process, and a number of innovative biomaterials; functionally graded materials are presented in a dedicated section: they allow customizing prosthesis features with respect to the host bone. Conclusions recommend an integrated approach for the production of new prosthetic devices: the “engineering community” has to support the “medical community” to assure an effective translation of research results into clinical practice.
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Thevendran G, Khanduja V. SICOT PIONEER (Programme of Innovative Orthopaedic Networking Education and Research): Re-inventing global orthopaedic education, training and research. INTERNATIONAL ORTHOPAEDICS 2022; 46:669-676. [PMID: 35267073 PMCID: PMC8907392 DOI: 10.1007/s00264-022-05354-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Gowreeson Thevendran
- Mount Elizabeth Novena Hospital, 38 Irrawaddy Road, Singapore, 329563, Singapore
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospital, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
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Failure of Orthopaedic Residents to Voluntarily Participate in a Laboratory Skills Training. J Am Acad Orthop Surg 2022; 30:161-167. [PMID: 34910714 DOI: 10.5435/jaaos-d-21-00680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Arthroscopy simulation is increasingly used in orthopaedic residency training. The implementation of a curriculum to accommodate these new training tools is a point of interest. We assessed the use of a high-fidelity arthroscopy simulator in a strictly voluntary curriculum to gauge resident interest and educational return. METHODS Fifty-eight months of simulator use data were collected from a single institution to analyze trends in resident use. Comparable data from two additional residency programs were analyzed as well, for comparison. Orthopaedic residents were surveyed to gauge interest in continued simulation training. RESULTS Average annual simulator use at the study institution was 27.7 hours (standard deviation = 26.8 hours). Orthopaedic residents spent an average of 1.7 hours practicing on the simulation trainer during the observation period. A total of 21% of residents met or exceeded a minimum of 3 hours of simulation time required for skill improvement defined by literature. Most (86%) of the residents agreed that the simulator in use should become a mandated component of a junior resident training. CONCLUSION Although surgical simulation has a role in orthopaedic training, voluntary simulator use is sporadic, resulting in many residents not receiving the full educational benefits of such training. Implementation of a mandated simulation training curriculum is desired by residents and could improve the educational return of surgical simulators in residency training.
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Ponseti Clubfoot Casting: Factors That Affect Trainee Competency (Retrospective Observational Study). J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202202000-00009. [PMID: 35167507 PMCID: PMC8849277 DOI: 10.5435/jaaosglobal-d-22-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/18/2022]
Abstract
Introduction: This study investigates how previous simulation training and clinical experience affects trainee performance when manipulating a foot, applying a Ponseti clubfoot cast, and performing an Achilles tenotomy on a clubfoot simulator. Methods: Sixty-four Accreditation Council for Graduate Medical Education orthopaedic trainees participated in the 2017 to 2018 Top Gun (TG) skills competition at the International Pediatric Orthopaedic Symposium. Trainees were judged by expert pediatric orthopaedic surgeons on how they manipulated a clubfoot model, applied a cast, and performed a simulated tendoachilles tenotomy (TAT). An analysis was done to correlate the test variables with a contestant's TG Ponseti score. Results: Twenty-one contestants with previous residency training using synthetic clubfoot models scored higher (P = 0.007) than those trainees without training. Trainees who had applied >10 clubfoot casts and who participated in >10 TATs in training also scored higher (P = 0.038 and P = 0.01, respectively). Thirteen contestants who had previously attended an International Pediatric Orthopaedic Symposium meeting and seven contestants who attended a American Academy of Orthopaedic Surgery clubfoot workshop scored higher (P = 0.012 and P = 0.017 respectively). Discussion: Clinical and previous simulation experience related to the Ponseti method correlated with improved performance on our Ponseti simulation. Trainees who had previous experience with >10 clubfoot casts and >10 TATs scored higher during TG than less experienced trainees.
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Guérinot C, Marcon V, Godard C, Blanc T, Verdier H, Planchon G, Raimondi F, Boddaert N, Alonso M, Sailor K, Lledo PM, Hajj B, El Beheiry M, Masson JB. New Approach to Accelerated Image Annotation by Leveraging Virtual Reality and Cloud Computing. FRONTIERS IN BIOINFORMATICS 2022; 1:777101. [PMID: 36303792 PMCID: PMC9580868 DOI: 10.3389/fbinf.2021.777101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023] Open
Abstract
Three-dimensional imaging is at the core of medical imaging and is becoming a standard in biological research. As a result, there is an increasing need to visualize, analyze and interact with data in a natural three-dimensional context. By combining stereoscopy and motion tracking, commercial virtual reality (VR) headsets provide a solution to this critical visualization challenge by allowing users to view volumetric image stacks in a highly intuitive fashion. While optimizing the visualization and interaction process in VR remains an active topic, one of the most pressing issue is how to utilize VR for annotation and analysis of data. Annotating data is often a required step for training machine learning algorithms. For example, enhancing the ability to annotate complex three-dimensional data in biological research as newly acquired data may come in limited quantities. Similarly, medical data annotation is often time-consuming and requires expert knowledge to identify structures of interest correctly. Moreover, simultaneous data analysis and visualization in VR is computationally demanding. Here, we introduce a new procedure to visualize, interact, annotate and analyze data by combining VR with cloud computing. VR is leveraged to provide natural interactions with volumetric representations of experimental imaging data. In parallel, cloud computing performs costly computations to accelerate the data annotation with minimal input required from the user. We demonstrate multiple proof-of-concept applications of our approach on volumetric fluorescent microscopy images of mouse neurons and tumor or organ annotations in medical images.
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Affiliation(s)
- Corentin Guérinot
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
- Sorbonne Université, Collège Doctoral, Paris, France
| | - Valentin Marcon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Charlotte Godard
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Thomas Blanc
- Sorbonne Université, Collège Doctoral, Paris, France
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, CNRS UMR168, Paris, France
| | - Hippolyte Verdier
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Histopathology and Bio-Imaging Group, Sanofi R&D, Vitry-Sur-Seine, France
- Université de Paris, UFR de Physique, Paris, France
| | - Guillaume Planchon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Francesca Raimondi
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Mariana Alonso
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Kurt Sailor
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Pierre-Marie Lledo
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Bassam Hajj
- Sorbonne Université, Collège Doctoral, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Mohamed El Beheiry
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Jean-Baptiste Masson
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
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XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis. J Clin Med 2022; 11:jcm11020470. [PMID: 35054164 PMCID: PMC8779726 DOI: 10.3390/jcm11020470] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
In recent years, with the rapid advancement and consumerization of virtual reality, augmented reality, mixed reality, and extended reality (XR) technology, the use of XR technology in spine medicine has also become increasingly popular. The rising use of XR technology in spine medicine has also been accelerated by the recent wave of digital transformation (i.e., case-specific three-dimensional medical images and holograms, wearable sensors, video cameras, fifth generation, artificial intelligence, and head-mounted displays), and further accelerated by the COVID-19 pandemic and the increase in minimally invasive spine surgery. The COVID-19 pandemic has a negative impact on society, but positive impacts can also be expected, including the continued spread and adoption of telemedicine services (i.e., tele-education, tele-surgery, tele-rehabilitation) that promote digital transformation. The purpose of this narrative review is to describe the accelerators of XR (VR, AR, MR) technology in spine medicine and then to provide a comprehensive review of the use of XR technology in spine medicine, including surgery, consultation, education, and rehabilitation, as well as to identify its limitations and future perspectives (status quo and quo vadis).
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Virtual Reality as a Learning Tool for Trainees in Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial. J Am Acad Orthop Surg 2022; 30:84-90. [PMID: 34520419 DOI: 10.5435/jaaos-d-20-01357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 08/11/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The efficacy of virtual reality (VR) as a teaching augment for arthroplasty has not been well examined for unfamiliar multistep procedures such as unicompartmental knee arthroplasty (UKA). This study sought to determine whether VR improves surgical competence over traditional procedural preparation when performing a UKA. METHODS Twenty-two orthopaedic surgery trainees were randomized to two surgical preparation cohorts: (1) "Guide" group (control) with access to manufacture's technique guide and surgical video and (2) "VR" group with access to an immersive commercially available VR learning module. Surgical performance of UKA on a SawBone model was assessed through time and the Objective Structured Assessment of Technical Skills (OSATS) validated rating system. RESULTS Participants were equally distributed among all training levels and previous exposure to UKA. No difference in mean surgical times was observed between Guide and VR groups (Guide = 42.4 minutes versus VR = 43.0 minutes; P = 0.9) or mean total OSATS (Guide = 15.7 versus VR = 14.2; P = 0.59). Most trainees felt VR would be a useful tool for resident education (77%) and would use VR for case preparation if available (86.4%). CONCLUSION In a randomized controlled trial of trainees at a single, large academic center performing a complex, multistep, unfamiliar procedure (UKA), VR training demonstrated equivalent surgical competence compared with the use of traditional technique guides, as measured by surgical time and OSATS scores. Most of the trainees found the VR technology beneficial. This study suggests that VR technology may be considered as an adjunct to traditional surgical preparation/training methods.
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Myers TG, Marsh JL, Nicandri G, Gorczyca J, Pellegrini VD. Contemporary Issues in the Acquisition of Orthopaedic Surgical Skills During Residency: Competency-Based Medical Education and Simulation. J Bone Joint Surg Am 2022; 104:79-91. [PMID: 34752441 DOI: 10.2106/jbjs.20.01553] [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: 02/01/2023]
Abstract
➤ Orthopaedic education should produce surgeons who are competent to function independently and can obtain and maintain board certification. ➤ Contemporary orthopaedic training programs exist within a fixed 5-year time frame, which may not be a perfect match for each trainee. ➤ Most modern orthopaedic residencies have not yet fully adopted objective, proficiency-based, surgical skill training methods despite nearly 2 decades of evidence supporting the use of this methodology. ➤ Competency-based medical education backed by surgical simulation rooted in proficiency-based progression has the potential to address surgical skill acquisition challenges in orthopaedic surgery.
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Affiliation(s)
- Thomas G Myers
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | | | - Gregg Nicandri
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - John Gorczyca
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - Vincent D Pellegrini
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Anetzberger H, Becker R, Eickhoff H, Seibert FJ, Döring B, Haasters F, Mohr M, Reppenhagen S. The Diagnostic Arthroscopy Skill Score (DASS): a reliable and suitable assessment tool for arthroscopic skill training. Knee Surg Sports Traumatol Arthrosc 2022; 30:349-360. [PMID: 33914120 DOI: 10.1007/s00167-021-06554-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To develop and validate a novel score to more objectively assess the performance of diagnostic knee arthroscopy using a simulator. METHODS A Diagnostic Arthroscopy Skill Score (DASS) was developed by ten AGA (AGA-Society for Arthroscopy and Joint-Surgery) instructors for the assessment of arthroscopic skills. DASS consists of two parts: the evaluation of standardized diagnostic knee arthroscopy (DASSpart1) and the evaluation of manual dexterity, including ambidexterity and triangulation, using objective measurement parameters (DASSpart2). Content validity was determined by the Delphi method. One hundred and eleven videos of diagnostic knee arthroscopies were recorded during simulator training courses and evaluated by six specially trained instructors using DASS. Construct validity, measurement error calculated by the minimum detectable change (MDC), internal consistency using Cronbach's alpha and interrater and intrarater reliability were assessed. The Bland-Altman method was used to calculate the intrarater agreement. RESULTS Six skill domains were identified and evaluated for each knee compartment. DASS, DASSpart1, and DASSpart2 showed construct validity, with experts achieving significantly higher scores than competents and novices. MDC was 4.5 ± 1.7 points for DASSpart1. There was high internal consistency for all domains in each compartment from 0.78 to 0.86. The interrater reliability showed high agreement between the six raters (ICC = 0.94). The evaluation of intrarater reliability demonstrated good and excellent agreement for five raters (ICC > 0.80) and moderate agreement for one rater (ICC = 0.68). The Bland-Altman comparison showed no difference between the first and second evaluations in five out of six raters. Precision, estimated by the regression analysis and comparison with the method of Bland and Altman, was excellent for four raters and moderate for two raters. CONCLUSIONS The results of this study indicate good validity and reliability of DASS for the assessment of the surgical performance of diagnostic knee arthroscopy during simulator training. Standardized training is recommended before arthroscopy surgery is considered in patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Hermann Anetzberger
- Orthopädische Gemeinschaftspraxis am OEZ, Hanauer Str. 65, 80993, Munich, Germany.
| | - Roland Becker
- Zentrum für Orthopädie und Unfallchirurgie, Medizinische Hochschule Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
| | - Hansjörg Eickhoff
- Orthopädie und Unfallchirurgie, Abteilung Arthroskopie u. Schulterchirurgie, GFO-Kliniken Troisdorf, Hospitalstr. 45, 53840, Troisdorf, Germany
| | - Franz Josef Seibert
- Medizinische Universität Graz, Universitätsklinik für Orthopädie und Traumatologie LKH-Uniklinikum, Auenbruggerplatz 7a, 8010, Graz, Austria
| | - Bernd Döring
- Zentrum für Orthopädie und Unfallchirurgie, Medizinische Hochschule Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
| | - Florian Haasters
- Schönklinik München Harlaching, Harlachinger Straße 51, 81547, Munich, Germany
| | - Michael Mohr
- Orthopädisches Zentrum Bad Säckingen, Rudolf-Eberle-Platz 3, 79713, Bad Säckingen, Germany
| | - Stephan Reppenhagen
- Orthopädische Klinik König-Ludwig-Haus, Brettreichstraße 11, 97074, Würzburg, Germany
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Virtual Simulation for Interactive Visualization of 3D Fracture Fixation Biomechanics. J Am Acad Orthop Surg 2022; 30:e51-e58. [PMID: 34370717 PMCID: PMC8692361 DOI: 10.5435/jaaos-d-20-01322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/06/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In the surgical fixation of fractures, proper biomechanical stability is key in preventing clinical complications including poor fracture healing, residual deformity, loss of fixation, or implant failure. Stability is largely influenced by treatment decisions made by the surgeon. The interplay of surgeon-controlled variables and their effect on the three-dimensional (3D) biomechanics of a fracture fixation construct are often not intuitive, and current training methods do not facilitate a deep understanding of these interactions. METHODS A simulation software interface, FracSim, was developed. FracSim is built on a large precomputed library of finite element simulations. The software allows a surgeon to make adjustments to a virtual fracture fixation construct/weight-bearing plan and immediately visualize how these changes affect 3D biomechanics, including implant stress and fracture gap strain, important for clinical success. Twenty-one orthopaedic residents completed an instructor-led educational session with FracSim focused on bridge plating. Subjects completed pretests and posttests of knowledge of biomechanical concepts and a questionnaire. RESULTS Subjects scored a mean of 5.6/10 on the pretest of biomechanical knowledge. Senior residents scored better than junior residents (P = 0.04). After the educational session with FracSim, residents improved their test scores to a mean of 8.0/10, with a significant improvement (P < 0.001). Questionnaire scores indicated that subjects believed that FracSim had realistic implants, constructs, and motions and that training with FracSim was purposeful, desirable, efficient, fun, and useful for enhancing the understanding of fracture fixation biomechanics. DISCUSSION This new type of simulation software enables interactive visualization of 3D fracture fixation biomechanics. Limitations of this study include lack of a control group undergoing traditional education and lack of a delayed posttest to assess retention. FracSim may provide an effective and engaging way to promote a deeper understanding of biomechanical concepts in the orthopaedic learner.
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Pearl MC, Madariaga MC, Blum C, Lynch B, Komatsu DE, Barsi J. Clubfoot Cast Simulation Using Pressure Sensors: A Novel Way to Teach the Ponseti Method. JOURNAL OF SURGICAL EDUCATION 2022; 79:237-242. [PMID: 34538763 DOI: 10.1016/j.jsurg.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/25/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The standard of care in treating congenital clubfoot is the Ponseti method. Resident education of this skill traditionally involves direct casting of patients with attending feedback. With increased clinical time demands, mastery of the skill may not be achievable using direct resident - patient interactions. We describe a novel Ponseti cast simulator using pressure sensors to teach this skill. DESIGN A novel Ponseti cast simulator was constructed using a standardized model and pressure sensors. A pre-training baseline (trial 1) and post education (trial 2) was made and scored using an objective structured assessment of technical skill (OSATS) checklist. Pressure sensors were placed at the first metatarsal and talar head to record cast forces. SETTING The study was performed in the Department of Orthopedic Surgery at an academic tertiary care hospital. PARTICIPANTS Study participants included 6 junior orthopedic residents defined as post-graduate year (PGY) 1 to 3, 6 senior orthopedic residents (PGY 4,5), and a board -certified pediatric orthopedic surgeon to serve as a control. RESULTS Trial 1 OSATS scores were significantly higher in senior residents (9.7 ± 1.5) than junior residents (5.2 ± 1.2) (p = 0.004). Trial 2 OSATS scores were also significantly higher in senior residents than junior residents: 13.7 ± 1.4 vs. 5.8 ± 1.6 (p = 0.003). Additionally, senior residents significantly improved scores between the first 2 trials 9.7 ± 1.5 vs. 13.7 ± 1.4 (p = 0.003), while junior residents did not 5.2 ± 1.2 vs. 5.8 ± 1.6 (p = 0.4566). In addition, there were no significant differences between junior, and senior resident Trial 1 talar head pressures or first metatarsal pressures, or Trial 2 first metatarsal pressures. CONCLUSIONS This is the first casting simulation model to use pressure sensors as a way to objectively measure cast application pressure. This simulator may be useful in an orthopedic training programs to teach Ponseti casting.
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Affiliation(s)
| | | | | | - Brian Lynch
- Stony Brook University, Stony Brook, New York
| | | | - James Barsi
- Stony Brook University, Stony Brook, New York.
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Goh GS, Lohre R, Parvizi J, Goel DP. Virtual and augmented reality for surgical training and simulation in knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:2303-2312. [PMID: 34264380 DOI: 10.1007/s00402-021-04037-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Immersive virtual reality (IVR), augmented reality and mixed reality form a spectrum of extended reality technology integration that has gained popularity in orthopaedics recently. This review article examines the role of extended reality technologies in knee arthroplasty. METHODS Existing literature on the applications of extended reality technologies in preoperative planning and intraoperative navigation were reviewed. A sample workflow of a novel IVR simulator for improving surgical training was also provided to demonstrate its utility in educating trainees on knee arthroplasty techniques. RESULTS Extended reality technologies enable the surgeon to visualise patient-specific anatomy in real-time, enhancing preoperative planning and providing intraoperative guidance. IVR technology has the potential to revolutionise modern surgical training and optimise surgical performance in a cost-efficient manner, with current evidence demonstrating favourable immediate skill acquisition and transfer. CONCLUSIONS Extended reality technologies have a myriad of potential applications in orthopaedic surgery. Further research is needed to evaluate the cost-effectiveness of its incorporation into training programmes.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Lohre
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Danny P Goel
- Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada. .,Department of Orthopaedic Surgery, University of British Columbia, 321 Water Street, Suite 500, Vancouver, BC, V6B 1B8, Canada.
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Alpaugh K, Ast MP, Haas SB. Immersive technologies for total knee arthroplasty surgical education. Arch Orthop Trauma Surg 2021; 141:2331-2335. [PMID: 34652513 DOI: 10.1007/s00402-021-04174-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/06/2021] [Indexed: 12/30/2022]
Abstract
The need to adapt surgical curricula to meet the demands of an increasingly restrictive training environment is rising. Modern constraints of surgical trainees including work-hour restrictions and concerns surrounding patient safety have created an opportunity to supplement traditional teaching methods with developing immersive technologies including virtual and augmented reality. Virtual reality (VR) and augmented reality (AR) have been preliminarily investigated as it relates to total joint arthroplasty. The purpose of this article is to discuss VR and AR as it applies to modern total knee replacement (TKR) surgical education.
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Affiliation(s)
- Kyle Alpaugh
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E. 70th Street, New York, NY, 10021, USA.
- Division of Hip and Knee Replacement, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Michael P Ast
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E. 70th Street, New York, NY, 10021, USA
| | - Steven B Haas
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E. 70th Street, New York, NY, 10021, USA
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Stathakarou N, Sonesson L, Lundberg L, Boffard KD, Kononowicz AA, Karlgren K. Teams managing civilian and military complex trauma: What are the competencies required in austere environments and the potential of simulation technology to address them? Health Informatics J 2021; 27:14604582211052253. [PMID: 34821149 DOI: 10.1177/14604582211052253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Surgical training in civilian hospitals may not be sufficient for managing complex trauma in a setting where such care is not commonly practiced. Understanding the challenges that civilian teams face when moving to austere environments can inform the competencies that need to be trained. The aim of this study was to explore the competencies required in austere environments for teams managing complex trauma, and how they can be trained with simulation technologies. Ethnographic field observations were conducted, and field notes were synthesized. The field notes were structured with the elements of Activity Theory to generate the teams' competencies that need to be trained. A literature review was conducted to verify the results and identify examples of relevant simulation modalities. The analysis resulted in a structured list of competencies for civilian teams to manage complex trauma in an austere environment and recommendations which simulation technologies could be used in training of those competencies based on published studies. Our study contributes to understanding the challenges that civilian teams face when operating in an austere environment. A systematized list of competencies with suggested simulation technologies directs future research to improve quality of complex trauma training in civilian and military collaboration.
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Affiliation(s)
- Natalia Stathakarou
- Department of Learning, Infortmatics, Management and Ethics (LIME), 27106Karolinska Institutet, Stockholm, Sweden
| | - Linda Sonesson
- Collaborative Partnerships Office, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lars Lundberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kenneth D Boffard
- Department of Surgery, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, 49573Jagiellonian University Medical College, Kraków, Poland
| | - Klas Karlgren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Research, Education and Development and Innovation, Södersjukhuset, Sweden.,Faculty of Health and Social Sciences, Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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43
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Peng C, Ng KM, Roszczynialski KN, Warrington SJ, Schertzer K. Rapid Cycle Deliberate Practice in Virtual Reality: Teaching Transvenous Pacemaker Insertion to Emergency Medicine Residents. Cureus 2021; 13:e18503. [PMID: 34754663 PMCID: PMC8569655 DOI: 10.7759/cureus.18503] [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] [Accepted: 10/05/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Transvenous pacemaker insertion is a critical life-saving procedure that is infrequently performed. Traditional mannequin-based training paradigms are resource intensive and sometimes inadequate due to time constraints. Rapid Cycle Deliberate Practice (RCDP) is an effective teaching modality for highly scripted procedures. We propose using a simulation-based technique of RCDP in virtual reality (VR) to teach this procedure. Methods Sixteen emergency medicine residents were recruited. A pre-survey was administered at the start of the session, followed by a baseline task trainer checklist-based assessment. This checklist was created based on expert consensus. Participants then underwent the RCDP VR intervention with a subsequent repeat checklist-based assessment as well as a post-survey. Results Post-test scores were found to be significantly higher than pre-test scores after residents completed VR deliberate practice simulation (19.5±3.5 vs 24.1±2.0; p<0.001). Subanalysis did not reveal any significant difference based on post-graduate year, previous performance of procedure on a live patient, or previous VR experience. The experience increased participant feelings of preparedness and comfort in performing the procedure (2-disagree vs 4-agree) based on a 5-point Likert scale. Conclusions Virtual reality using RCDP to teach transvenous pacemaker insertion demonstrated an improvement in task trainer performance. Further investigation into whether this translates into better patient outcomes or can be generalized to other procedures needs to be considered.
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Affiliation(s)
- Cynthia Peng
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
| | - Kristen M Ng
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
| | | | - Steven J Warrington
- Emergency Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Kimberly Schertzer
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
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Hasan LK, Haratian A, Kim M, Bolia IK, Weber AE, Petrigliano FA. Virtual Reality in Orthopedic Surgery Training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1295-1301. [PMID: 34785971 PMCID: PMC8590940 DOI: 10.2147/amep.s321885] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/25/2021] [Indexed: 06/09/2023]
Abstract
One emerging technology with the potential to improve and further transform the field of orthopaedic surgery is virtual reality (VR). VR has been explored and used in many different specialties with clinical applications, such as psychiatric therapy, pain management, rehabilitation, and traumatic brain injury. Recent studies have suggested that the use of VR during the training of orthopaedic surgery residents produces similar or improved surgical performance by residents. This is an area where VR can provide a tremendous benefit to the field of orthopaedic surgery, as it offers a safe and accessible complement to orthopaedic surgical training outside of the operating room (OR) and without involving patients directly. This review will elucidate the current state of virtual reality use in the training of orthopaedic surgeons and highlight key benefits and challenges in its application as a training resource.
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Affiliation(s)
- Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Michael Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Feeley A, Turley L, Sheehan E, Merghani K. A Portable Hip Arthroscopy Simulator Demonstrates Good Face and Content Validity with Incomplete Construct Validity. Arthrosc Sports Med Rehabil 2021; 3:e1287-e1293. [PMID: 34712965 PMCID: PMC8527255 DOI: 10.1016/j.asmr.2021.05.009] [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: 12/26/2020] [Accepted: 05/29/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose We evaluate the face, content, and construct validity of a portable hip arthroscopy module in a regional orthopaedic unit. Methods Participants were recruited from a regional orthopaedic centre, and categorized into novice (0 arthroscopies), intermediate (1-29 arthroscopies), and expert (>50 arthroscopies) groups based on reported experience in arthroscopy. Face and content validity was evaluated by feedback from users immediately following completion of modules. Objective measurements, including time taken and subjective measurements consisting of simulation software metrics including, cam lesion locations attempts, scope strikes on bone, healthy bone burred, and cam lesion burred. Scores achieved by experts were recorded, and the median score was set at the level at which proficiency was demonstrated. Participant feedback on perceived educational use was collected following completion. Results In total, 20 participant results were included for analysis. Good face and content validity was expressed by participants with previous arthroscopic experience. Number of scope strikes within the simulator-derived metrics accurately discerned between levels of experience. Novices had a mean of 5 strikes per attempt (SD ± 5 ) , intermediates a mean of 5.8 strikes (SD ± 4.1). There was a significant difference between expert and novice groups (P = .01), and expert and intermediate groups (P = .002). No significant difference between overall performance scores achieved by participants in expert, intermediate, and novice groups (62% ± 19 vs 55% ± 22 vs 50% ± 23 , P = .15). This demonstrates incomplete construct validity of the simulator software-derived metrics. Conclusions This hip arthroscopy simulator demonstrated acceptable face and content validity, with incomplete construct validity of simulator software metrics. Participants reported high levels of satisfaction with the module, highlighting that the addition of haptic feedback would be beneficial to improve procedural steps. Incorporation of tactile feedback to the modulator components would likely enable the software to accurately delineate between levels of experience. Clinical Relevance This study demonstrates good face and content validity. The addition of haptic feedback in a hip arthroscopy simulator may improve learning.
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Affiliation(s)
- Aoife Feeley
- Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Arden, Road, Tullamore, Co. Offaly, Ireland.,Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland
| | - Luke Turley
- Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Arden, Road, Tullamore, Co. Offaly, Ireland
| | - Eoin Sheehan
- Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Arden, Road, Tullamore, Co. Offaly, Ireland.,Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland
| | - Khalid Merghani
- Department of Trauma and Orthopaedic Surgery, Tullamore Hospital, Arden, Road, Tullamore, Co. Offaly, Ireland
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Bartlett J, Kazzazi F, To K, Lawrence J, Khanduja V. Virtual Reality Simulator Use Stimulates Medical Students' Interest in Orthopaedic Surgery. Arthrosc Sports Med Rehabil 2021; 3:e1343-e1348. [PMID: 34712972 PMCID: PMC8527266 DOI: 10.1016/j.asmr.2021.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/11/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate whether the use of a VR arthroscopic simulator can influence medical students’ attitudes toward a career in orthopaedic surgery. Methods Twenty-five medical students completed seven unsupervised sessions on a VR hip-arthroscopic simulator. All participants completed a pre-simulator and post-simulator pseudo-anonymized questionnaire consisting of 10 questions: six 10-point Likert scale questions addressing their interest in orthopaedics, surgery, and arthroscopy; and four 5-point Likert scale questions addressing their attitudes toward simulation. Prepaired and postpaired datasets were analyzed using Wilcoxon signed rank test. Results Interest in both orthopaedics and surgery was found to increase after simulator use (orthopaedics: 5.3 ± .3 to 8.4 ± .2, P = .0001; surgery: 5.8 ± .3 to 9.0 ± .2; P = .0001). It was also found that simulator use increased participants’ interest in arthroscopy (5.4 ± .3 to 8.0 ± .3; P = .0001) and hip-arthroscopy (5.0 ± .3 to 7.6 ± .3; P = .0001). Participants reported they were more likely to attend endoscopic and arthroscopic surgical lists after simulator use (endoscopic: 6.9 ± .3 to 8.4 ± .2; P = .0003; arthroscopic: 5.9 ± .3 to 8.4 ± .2; P = .0001). After using the simulator, participants felt more strongly that VR simulation is a valuable training modality (P = .0025), that simulation should be a mandatory part of orthopaedics and surgical training (P = .0001 and P = .0001), and that access to VR simulators improves the quality of surgical training (P = .0024). Conclusions These results demonstrate that exposure to VR arthroscopic simulation increased medical students’ interest in orthopaedics, surgery, and arthroscopy, without the need for direct supervision. Following VR simulator use, students reported they were more likely to engage with training opportunities, including arthroscopic and endoscopic surgery. Clinical Relevance Understanding factors that stimulate interest in orthopaedic surgery may help programs attract the broadest pool of potential trainees.
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Affiliation(s)
- Jonathan Bartlett
- Cambridge University School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
| | - Fawz Kazzazi
- Cambridge University School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
| | - Kendrick To
- Cambridge University School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
| | - John Lawrence
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
| | - Vikas Khanduja
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom
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James HK, Chapman AW, Pattison GTR, Fisher JD, Griffin DR. Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training: A Systematic Review. JBJS Rev 2021; 8:e1900167. [PMID: 33006464 PMCID: PMC7360100 DOI: 10.2106/jbjs.rvw.19.00167] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Robust assessment of skills acquisition and surgical performance during training is vital to ensuring operative competence among orthopaedic surgeons. A move to competency-based surgical training requires the use of tools that can assess surgical skills objectively and systematically. The aim of this systematic review was to describe the evidence for the utility of assessment tools used in evaluating operative performance in trauma and orthopaedic surgical training. METHODS We performed a comprehensive literature search of MEDLINE, Embase, and Google Scholar databases to June 2019. From eligible studies we abstracted data on study aim, assessment format (live theater or simulated setting), skills assessed, and tools or metrics used to assess surgical performance. The strengths, limitations, and psychometric properties of the assessment tools are reported on the basis of previously defined utility criteria. RESULTS One hundred and five studies published between 1990 and 2019 were included. Forty-two studies involved open orthopaedic surgical procedures, and 63 involved arthroscopy. The majority (85%) were used in the simulated environment. There was wide variation in the type of assessment tools in used, the strengths and weaknesses of which are assessor and setting-dependent. CONCLUSIONS Current technical skills-assessment tools in trauma and orthopaedic surgery are largely procedure-specific and limited to research use in the simulated environment. An objective technical skills-assessment tool that is suitable for use in the live operative theater requires development and validation, to ensure proper competency-based assessment of surgical performance and readiness for unsupervised clinical practice. CLINICAL RELEVANCE Trainers and trainees can gain further insight into the technical skills assessment tools that they use in practice through the utility evidence provided.
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Affiliation(s)
- Hannah K James
- 1Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom 2Department of Trauma & Orthopedic Surgery, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
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Feeley A, Feeley I, Merghani K, Sheehan E. A pilot study to evaluate the face & construct validity of an orthopaedic virtual reality simulator. Injury 2021; 52:1715-1720. [PMID: 33926708 DOI: 10.1016/j.injury.2021.04.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/10/2021] [Indexed: 02/07/2023]
Abstract
AIMS This study aimed to identify the face and construct validity of the Precision OS trauma module proximal femoral nail procedure. Secondary outcomes included perceived use of simulation in surgical training, with structured feedback from participants. METHODS A comparative interventional study was carried out in a regional orthopaedics trauma unit hospital. Volunteers were stratified into novice, intermediate and expert groups based on self-reported levels of experience. Each participant carried out a simulated proximal femoral nail on an immersive virtual platform following instruction on its use, with objective metrics such as time and x-rays, and novel metrics calculated by the simulation module recorded. Face validity was also assessed. RESULTS The proximal femoral nail module demonstrated construct validity. Kruskal Wallis test demonstrated a statistically significant difference across all group's novel performance (p=.018). Intermediate surgeons performed significantly better than novices (P=.022), with shorter procedural times (P=.018) Three of the intermediate group achieved the proficiency level set by the expert group, with no significant difference noted between these two groups (=.06). Time taken to completion for expert surgeons was less than intermediate group, although this did not reach significance (P=.19). CONCLUSION The proximal femoral nail module on the Precision OS platform demonstrated good face, and construct validity. Further research evaluating use of virtual platform simulation in surgical trauma training is needed.
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Affiliation(s)
- Aoife Feeley
- Midlands Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly R35 NY51, Ireland.
| | - Iain Feeley
- Midlands Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly R35 NY51, Ireland
| | - Khalid Merghani
- Midlands Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly R35 NY51, Ireland
| | - Eoin Sheehan
- Midlands Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly R35 NY51, Ireland
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Huri G, Gülşen MR, Karmış EB, Karagüven D. Cadaver versus simulator based arthroscopic training in shoulder surgery. Turk J Med Sci 2021; 51:1179-1190. [PMID: 33421972 PMCID: PMC8283431 DOI: 10.3906/sag-2011-71] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/07/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction There are few studies that compare the cadaver dissections with the medical simulators in means of talent improvement. Therefore, the aim of this study is to find out if using cadaver dissections is still the golden standard for surgical training or using the medical simulators in surgery could replace cadaver dissections. Materials and methods The study is conducted during the European Orthopaedics & Traumatology Education Platform accredited Shoulder Club International Cadaver Course including a number of 34 orthopedics trainees. The participants were randomly divided into two groups to be trained with the simulator (Group 1) and on cadavers (Group 2), followed by a test performed on shoulder arthroscopy simulator (Virtamed ArthroS, Switzerland). There was no conflict of interest before, during, or after the study. Informed consent was obtained from all individual participants included in the study. Results Group 2 had statistically significant higher simulation overview procedure time values than Group 1 (p < 0.05), the meaning of which is participants trained with the simulator completed the given tasks in a shorter period of time. Group 2 had statistically significant higher scratching of humerus cartilage values than Group 1 (p < 0.05), which means that participants trained with simulation have less scratching done on the humerus cartilage than the participants trained on a cadaver. Conclusion To the best of our knowledge, this study is the first one to compare virtual reality (VR) simulators with cadavers for surgical education in an objective manner, while using qualitative and quantitative data. According to this study, it is possible to state that VR simulators are just as effective as cadavers in means of training subjects. As medical education will face a total change all around the world after the COVID-19 pandemic, this study has the potential to be an important guide during and after this period.
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Affiliation(s)
- Gazi Huri
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University Ankara, Turkey
| | | | | | - Doğaç Karagüven
- Department of Orthopedics, Faculty of Medicine, Ufuk University, Ankara, Turkey
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Popescu D, Marinescu R, Laptoiu D, Deac GC, Cotet CE. DICOM 3D viewers, virtual reality or 3D printing - a pilot usability study for assessing the preference of orthopedic surgeons. Proc Inst Mech Eng H 2021; 235:1014-1024. [PMID: 34176364 DOI: 10.1177/09544119211020148] [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: 12/27/2022]
Abstract
As standard practice in orthopedic surgery, the information gathered by analyzing Computer Tomography (CT) 2D images is used for patient diagnosis and planning surgery. Lately, these virtual slices are the input for generating 3D virtual models using DICOM viewers, facilitating spatial orientation, and diagnosis. Virtual Reality (VR) and 3D printing (3DP) technologies are also reported for use in anatomy visualization, medical training, and diagnosis. However, it has not been yet investigated whether the surgeons consider that the advantages offered by 3DP and VR outweigh their development efforts. Moreover, no comparative evaluation for understanding surgeon's preference in using these investigation tools has been performed so far. Therefore, in this paper, a pilot usability test was conducted for collecting surgeons' opinions. 3D models of knee, hip and foot were displayed using DICOM 3D viewer, two VR environments and as 3D-printed replicas. These tools adequacy for diagnosis was comparatively assessed in three cases scenarios, the time for completing the diagnosis tasks was recorded and questionnaires filled in. The time for preparing the models for VR and 3DP, the resources needed and the associated costs were presented in order to provide surgeons with the whole context. Results showed a preference in using desktop DICOM viewer with 3D capabilities along with the information provided by Unity-based VR solution for visualizing the virtual model from various angles challenging to analyze on the computer screen. 3D-printed replicas were considered more useful for physically simulating the surgery than for diagnosis. For the VR and 3DP models, the lack of information on bone quality was considered an important drawback. The following order of using the tools was preferred: DICOM viewer, followed by Unity VR and 3DP.
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Affiliation(s)
- Diana Popescu
- Department of Robotics and Production Systems, University Politehnica of Bucharest, Bucharest, Romania
| | - Rodica Marinescu
- University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Dan Laptoiu
- Department of Orthopedics, Colentina Clinical Hospital, Bucharest, Romania
| | - Gicu Calin Deac
- Department of Robotics and Production Systems, University Politehnica of Bucharest, Bucharest, Romania
| | - Costel Emil Cotet
- Department of Robotics and Production Systems, University Politehnica of Bucharest, Bucharest, Romania
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