The purpose of this study was to review the published literature on modern arthroscopic simulator training models to (1) determine the ability to transfer skills learned on the model to the operating room and (2) determine the learning curve required to translate such skills.
A systematic review of all studies using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. Two independent reviewers then analyzed studies deemed appropriate for inclusion. Study data collected included participant demographic characteristics, simulator model, type and number of tasks, method of analysis, and results of training, when available. Given the different methods used in each study, descriptive analysis was performed.
Nineteen studies met the inclusion criteria (9 shoulder, 9 knee, and 1 hip). A total of 465 participants with a mean age of 30 years were evaluated. Twelve studies (63%) compared task performance among participants of different experience levels, with 100% reporting a positive correlation between experience level and simulator performance. Eight studies (42%) evaluated task performance before and after simulator training, with 6 studies showing improvement after training; 1 study noted no difference in performance after 1 hour of training. One study commented on improved operating room performance after simulator training. No studies commented on the number of training sessions needed to translate skills learned on the models to the operating room.
This review suggests that practice on arthroscopic simulators improves performance on arthroscopic simulators. We cannot, however, definitively comment on whether simulator training correlates to an improved skill set in the operating room. Further work is needed to determine the type and number of training sessions needed to translate arthroscopic skills learned on the models to the operating room.
Level IV, systematic review of studies with Level I through IV evidence.
[Show abstract][Hide abstract] ABSTRACT: Background Context
The skills and knowledge that residents have to master has increased, yet the amount of hours that residents are allowed to work has been reduced. There is a strong need to improve training techniques to compensate for these changes. One approach is to use simulation-training methods to shorten the learning curve for surgeons in training.
To analyze the effect of surgical training using three-dimensional(3D) simulation on placement of lateral mass screws in the cervical spine on either cadavers or sawbones.
Study Design / Setting
Blinded Randomized Control Study
The Cervical Spine Research Society provided funding in the amount of $12,000 for this study. No other conflicts of interest were noted as our institution supplied financial support. Fifteen orthopaedic residents post-graduate year(PGY) 1-6 were asked to simulate Magerl lateral mass screw trajectories from C3-7 on cadavers using a navigated drill guide but with no feedback as to the actual trajectory within bone (Baseline1). This was repeated to determine baseline accuracy (Baseline2). They were then randomized into three groups: Group 1, Control, did not receive any training, while Groups 2 and 3 received 3D navigational feedback as to the intended drill trajectory on Sawbones and Cadavers, respectively. All three groups then performed final simulated drilling (FinalTest).
All 3D images were de-identified and reviewed by a blinded single fellowship trained orthopaedic spine surgeon. Each image/screw was measured for starting site, caudad/cephalad angle, and medial/lateral angle to determine trajectory accuracy.
The aggregate mean difference from a perfect screw was compiled for each session for each group. A negative difference shows improvement, while a positive difference shows regression. The difference between FinalTest and Baseline1 in the Control group was 2.4 degrees, suggesting regression. In contrast, the differences for groups Sawbone and Cadaver were -8.2 degrees and -7.2 degrees, respectively, suggesting improvement. When comparing the difference in aggregate sum angle for the Sawbones and Cadaver groups to the Control group, the difference was statistically significant (p<.0001).
L: Training with 3D navigation significantly improved the ability of orthopaedic residents to properly drill simulated lateral mass screws. As such, training with 3D navigation may be a useful adjunct in resident surgical education.
The Spine Journal 09/2014; 15(1). DOI:10.1016/j.spinee.2014.08.444 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical
techniques have made it increasingly difficult for trainees to develop expertise in their craft.
Working hour restrictions and a drive towards senior led care demands that proficiency be
gained in a shorter period of time whilst requiring a greater skill set than that in the past. The
resulting conflict between service provision and training has necessitated the development of
alternative methods in order to compensate for the reduction in ‘hands-on’ experience.
Simulation training provides the opportunity to develop surgical skills in a controlled
environment whilst minimising risks to patient safety, operating theatre usage and financial
expenditure. Many options for simulation exist within orthopaedics from cadaveric or
prosthetic models, to arthroscopic simulators, to advanced virtual reality and threedimensional
software tools. There are limitations to this form of training, but it has significant
potential for trainees to achieve competence in procedures prior to real-life practice. The
evidence for its direct transferability to operating theatre performance is limited but there are
clear benefits such as increasing trainee confidence and familiarity with equipment. With
progressively improving methods of simulation available, it is likely to become more
important in the ongoing and future training and assessment of orthopaedic surgeons.
Journal of Orthopaedic Surgery and Research 12/2014; 9(126). DOI:10.1186/s13018-014-0126-z · 1.39 Impact Factor
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