Simulation Training Improves Surgical Proficiency and Safety During Diagnostic Shoulder Arthroscopy Performed by Residents.

Although virtual reality simulators have established construct validity, no studies have proven transfer of skills from a simulator to improved in vivo surgical skill. The current authors hypothesized that simulation training would improve residents' basic arthroscopic performance and safety. Twenty-two orthopedic surgery trainees were randomized into simulation or standard practice groups. At baseline testing, all of the participants performed simulator-based testing and a supervised, in vivo diagnostic shoulder arthroscopy with video recording. The simulation group subsequently received 1 hour of total instruction during a 3-month period, and the standard practice group received no simulator training. After intervention, both groups were reevaluated with simulator testing and a second recorded diagnostic shoulder arthroscopy. Two blinded, independent experts evaluated arthroscopic performance using the anatomic checklist, Arthroscopic Surgery Skill Evaluation Tool (ASSET) score, and total elapsed time. All outcome measures were compared within and between groups. After intervention, mean time required by the simulation group to complete the simulator task (30.64 seconds) was 8±1.2 seconds faster than the time required by the control group (38.64 seconds; P=.001). Probe distance (51.65 mm) was improved by 41.2±6.08 mm compared with the control (92.83 mm; P=.001). When comparing ASSET safety scores, the simulation group was competent (3.29) and significantly better than the control group (3.00; P=.005) during final arthroscopic testing. This study establishes transfer validity for an arthroscopic shoulder simulator model. Simulator training for residents in training can decrease surgical times, improve basic surgical skills, and confer greater patient safety during shoulder arthroscopy. [Orthopedics. 2016; 39(3):e479-e485.].

Waterman BR ，Martin KD ，Cameron KL ，Owens BD ，Belmont PJ Jr ... -  《-》

Ankle Arthroscopy Simulation Improves Basic Skills, Anatomic Recognition, and Proficiency During Diagnostic Examination of Residents in Training.

The purpose of this study was to determine whether low-fidelity arthroscopic simulation training improves basic ankle arthroscopy performance and efficiency among orthopedic trainees. Twenty-nine orthopedic surgery trainees with varying levels of experience in ankle arthroscopy were randomized into either simulation or standard practice groups. At baseline testing, all participants performed simulator-based testing and a cadaveric diagnostic ankle arthroscopy with video recording. The simulation group subsequently received 4 one-on-one, 15-minute simulation training sessions over a 4-month period, while the standard practice group received no additional simulation training or exposure. After intervention, both groups were reevaluated with simulator testing and a second recorded cadaveric diagnostic ankle arthroscopy. Two blinded, independent experts evaluated each randomized arthroscopic performance using the 15-point checklist, Arthroscopic Surgery Skill Evaluation Tool (ASSET), and total elapsed time, and all outcome measures were compared within and between groups. Baseline arthroscopic experience, simulator task performance measures, and ASSET scores were equivalent between the simulation and standard practice groups. After completion of training, the simulation group outscored the control group in total ASSET score (34.9 vs 19.6; P < .001) and checklist score (14.5 vs 8.4; P < .001) and achieved nearly expert ASSET Safety scores (4.7 vs 2.9; P < .001) on the simulator model. Cadaver testing also demonstrated significant improvements in total ASSET score (28.8 vs 16.8; P < .001), checklist score (12.6 vs 7.1; P < .001), and ASSET Safety score (3.9 vs 2.6; P < .001). These results demonstrate that low-fidelity ankle arthroscopy simulation training can improve basic surgical skills, efficiency of movement, and anatomic recognition. The results suggest greater patient safety during ankle arthroscopy following simulation training. Level I, prospective comparative study.

Martin KD ，Patterson D ，Phisitkul P ，Cameron KL ，Femino J ，Amendola A ... -  《-》

Efficacy of standardized training on a virtual reality simulator to advance knee and shoulder arthroscopic motor skills.

Rahm S ，Wieser K ，Bauer DE ，Waibel FW ，Meyer DC ，Gerber C ，Fucentese SF ... -  《BMC MUSCULOSKELETAL DISORDERS》

Arthroscopic Shoulder Surgical Simulation Training Curriculum: Transfer Reliability and Maintenance of Skill Over Time.

Surgical education is evolving as work hour constraints limit the exposure of residents to the operating room. Potential consequences may include erosion of resident education and decreased quality of patient care. Surgical simulation training has become a focus of study in an effort to counter these challenges. Previous studies have validated the use of arthroscopic surgical simulation programs both in vitro and in vivo. However, no study has examined if the gains made by residents after a simulation program are retained after a period away from training. In all, 17 orthopedic surgery residents were randomized into simulation or standard practice groups. All subjects were oriented to the arthroscopic simulator, a 14-point anatomic checklist, and Arthroscopic Surgery Skill Evaluation Tool (ASSET). The experimental group received 1 hour of simulation training whereas the control group had no additional training. All subjects performed a recorded, diagnostic arthroscopy intraoperatively. These videos were scored by 2 blinded, fellowship-trained orthopedic surgeons and outcome measures were compared within and between the groups. After 1 year in which neither group had exposure to surgical simulation training, all residents were retested intraoperatively and scored in the exact same fashion. Individual surgical case logs were reviewed and surgical case volume was documented. There was no difference between the 2 groups after initial simulation testing and there was no correlation between case volume and initial scores. After training, the simulation group improved as compared with baseline in mean ASSET (p = 0.023) and mean time to completion (p = 0.01). After 1 year, there was no difference between the groups in any outcome measurements. Although individual technical skills can be cultivated with surgical simulation training, these advancements can be lost without continued education. It is imperative that residency programs implement a simulation curriculum and continue to train throughout the academic year.

Dunn JC ，Belmont PJ ，Lanzi J ，Martin K ，Bader J ，Owens B ，Waterman BR ... -  《-》

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 ... -  《-》