Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator. A randomized blinded study.

There is a paucity of articles in the surgical literature demonstrating transfer validity (transfer of training). The purpose of this study was to assess whether skills learned on the ArthroSim virtual-reality arthroscopic knee simulator transferred to greater skill levels in the operating room. Postgraduate year-3 orthopaedic residents were randomized into simulator-trained and control groups at seven academic institutions. The experimental group trained on the simulator, performing a knee diagnostic arthroscopy procedure to a predetermined proficiency level based on the average proficiency of five community-based orthopaedic surgeons performing the same procedure on the simulator. The residents in the control group continued their institution-specific orthopaedic education and training. Both groups then performed a diagnostic knee arthroscopy procedure on a live patient. Video recordings of the arthroscopic surgery were analyzed by five pairs of expert arthroscopic surgeons blinded to the identity of the residents. A proprietary global rating scale and a procedural checklist, which included visualization and probing scales, were used for rating. Forty-eight (89%) of the fifty-four postgraduate year-3 residents from seven academic institutions completed the study. The simulator-trained group averaged eleven hours of training on the simulator to reach proficiency. The simulator-trained group performed significantly better when rated according to our procedural checklist (p = 0.031), including probing skills (p = 0.016) but not visualization skills (p = 0.34), compared with the control group. The procedural checklist weighted probing skills double the weight of visualization skills. The global rating scale failed to reach significance (p = 0.061) because of one extreme outlier. The duration of the procedure was not significant. This lack of a significant difference seemed to be related to the fact that residents in the control group were less thorough, which shortened their time to completion of the arthroscopic procedure. We have demonstrated transfer validity (transfer of training) that residents trained to proficiency on a high-fidelity realistic virtual-reality arthroscopic knee simulator showed a greater skill level in the operating room compared with the control group. We believe that the results of our study will stimulate residency program directors to incorporate surgical simulation into the core curriculum of their residency programs.

Cannon WD ，Garrett WE Jr ，Hunter RE ，Sweeney HJ ，Eckhoff DG ，Nicandri GT ，Hutchinson MR ，Johnson DD ，Bisson LJ ，Bedi A ，Hill JA ，Koh JL ，Reinig KD ... -  《-》

Evaluation of skill level between trainees and community orthopaedic surgeons using a virtual reality arthroscopic knee simulator.

Cannon WD ，Nicandri GT ，Reinig K ，Mevis H ，Wittstein J ... -  《-》

Arthroscopy skills development with a surgical simulator: a comparative study in orthopaedic surgery residents.

Surgical simulation has become increasingly relevant to orthopaedic surgery education and could translate to improved operating room proficiency in orthopaedic surgery trainees. To compare the arthroscopic performance of junior orthopaedic surgery residents who received training with a knee and shoulder arthroscopy surgical simulator with those who received didactic training. Controlled laboratory study. Fourteen junior orthopaedic surgery residents at a single institution were randomized to receive knee and shoulder arthroscopy training with a surgical simulator (n = 8) or didactic lectures with arthroscopy models (n = 6). After their respective training, performance in diagnostic knee and shoulder arthroscopy was assessed using a cadaveric model. Time to completion and assessment of arthroscopic handling using a subjective injury grading index (scale, 1-10) was then used to evaluate performance in final cadaveric testing. Orthopaedic surgery residents who trained with a surgical simulator outperformed the didactic-trained residents in shoulder arthroscopy by time to completion (-35%; P = .02) and injury grading index (-35%; P = .01). In addition, a trend toward improved performance of knee arthroscopy by the simulator-trained group was found by time to completion (-36%; P = .09) and injury grading index (P = .08). In this study, junior orthopaedic surgery residents who trained with a surgical simulator demonstrated improved arthroscopic performance in both knee and shoulder arthroscopy. However, future validation of surgical simulator training for orthopaedic surgery residents remains warranted. Surgical skill development with an arthroscopy surgical simulator could translate to improved arthroscopy performance in the operating room.

Rebolledo BJ ，Hammann-Scala J ，Leali A ，Ranawat AS ... -  《-》

Improving Resident Performance in Knee Arthroscopy: A Prospective Value Assessment of Simulators and Cadaveric Skills Laboratories.

Cadaveric skills laboratories and virtual reality simulators are two common methods used outside of the operating room to improve residents' performance of knee arthroscopy. We are not aware of any head-to-head comparisons of the educational values of these two methodologies. The purpose of this prospective randomized trial was to assess the efficacy of these training methods, compare their rates of improvement, and provide economic value data to programs seeking to implement such technologies. Orthopaedic surgery residents were randomized to one of three groups: control, training on cadavera (cadaver group), and training with use of a simulator (simulator group). Residents completed pretest and posttest diagnostic knee arthroscopies on cadavera that were timed and video-recorded. Between the pretest and posttest, the control group performed no arthroscopy, the cadaver group performed four hours of practice on cadavera, and the simulator group trained for four hours on a simulator. All tests were scored in a blinded, randomized fashion using the validated Arthroscopy Surgical Skill Evaluation Tool (ASSET). The mean improvement in the ASSET score and in the time to complete the procedure were compared between the pretest and posttest and among the groups. Forty-five residents (fifteen per group) completed the study. The mean difference in the ASSET score from the pretest to the posttest was -0.40 (p = 0.776) in the control group, +4.27 (p = 0.002) in the cadaver group, and +1.92 (p = 0.096) in the simulator group (p = 0.015 for the comparison among the groups). The mean difference in the test-completion time (minutes:seconds) from the pretest to the posttest was 0:07 (p = 0.902) in the control group, 3:01 (p = 0.002) in the cadaver group, and 0:28 (p = 0.708) in the simulator group (p = 0.044 for the comparison among groups). Residents in the cadaver group improved their performance at a mean of 1.1 ASSET points per hour spent training whereas those in the simulator group improved 0.5 ASSET point per hour of training. Cadaveric skills laboratories improved residents' performance of knee arthroscopy compared with that of matched controls. Residents practicing on cadaveric specimens improved twice as fast as those utilizing a high-fidelity simulator; however, based on cost estimation specific to our institution, the simulator may be more cost-effective if it is used at least 300 hours per year. Additional study of this possibility is warranted.

Camp CL ，Krych AJ ，Stuart MJ ，Regnier TD ，Mills KM ，Turner NS ... -  《-》

Wrist Arthroscopy: Can We Gain Proficiency Through Knee Arthroscopy Simulation?

Wrist arthroscopy is a challenging discipline with limited training exposure during residency. The purpose of this study was to evaluate the effectiveness of virtual knee arthroscopy simulation training for gaining proficiency in wrist arthroscopy. Participants were recorded performing a cadaveric wrist arthroscopy simulation. The residents then practiced knee arthroscopy on a virtual reality simulator and repeated the wrist arthroscopy simulation. All videos were blinded prior to assessment. Proficiency was graded using the Arthroscopic Surgery Skill Evaluation Tool global rating scale. In addition, participants were asked to complete a survey assessing the value of the virtual reality knee arthroscopy simulator for wrist arthroscopy. Orthopaedic Surgery Residency Program, Carolinas Medical Center, a large, public, nonprofit hospital located in Charlotte, North Carolina. Orthopaedic residents at our center were asked to participate in the simulation training. Participation was voluntary and nonincentivized. All orthopaedic residents at our institution (N = 27) agreed to participate. In total, there were 10 Intern (PGY-0 and PGY-1), 10 Junior (PGY-2 and PGY-3), and 7 Senior (PGY-4 and PGY-5) residents. In addition, a fellowship-trained hand surgeon was recruited to participate in the study, performing the wrist arthoscopy simulation. Two additional fellowship-trained hand surgeons, for a total of 3, assessed the blinded videos. There was a trend toward better wrist Arthroscopic Surgery Skill Evaluation Tool scores by training level, although the difference was not statistically significant. Interns improved by an average of 1.8 points between baseline and postknee simulation tests. Junior and senior residents decreased by 1.6 and 5.0 points, respectively. Knee arthroscopy simulation training did not objectively improve wrist arthroscopy proficiency among residents. A wrist-specific arthroscopy simulation program is needed if measurable competence through simulation is desired.

Ode G ，Loeffler B ，Chadderdon RC ，Haines N ，Scannell B ，Patt J ，Gaston G ... -  《-》