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

W. Dilworth Cannon, William E. Garrett, Robert E. Hunter, Howard J. Sweeney, Donald G. Eckhoff, Gregg T. Nicandri, Mark R. Hutchinson, Donald D. Johnson, Leslie J. Bisson, Asheesh Bedi, James A Hill, Jason L. Koh, Karl D. Reinig

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background: 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.

Methods: 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.

Conclusions: 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.

Clinical Relevance: 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.

Results: 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.

Original languageEnglish (US)
Pages (from-to)1798-1806
Number of pages9
JournalJournal of Bone and Joint Surgery - American Volume
Volume96
Issue number21
DOIs
StatePublished - Nov 5 2014

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Arthroscopy
Internship and Residency
Knee
Control Groups
Checklist
Operating Rooms
Orthopedics
Video Recording
Curriculum
Education
Weights and Measures
Transfer (Psychology)

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Cannon, W. D., Garrett, W. E., Hunter, R. E., Sweeney, H. J., Eckhoff, D. G., Nicandri, G. T., ... Reinig, K. D. (2014). Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator: A randomized blinded study. Journal of Bone and Joint Surgery - American Volume, 96(21), 1798-1806. https://doi.org/10.2106/JBJS.N.00058
Cannon, W. Dilworth ; Garrett, William E. ; Hunter, Robert E. ; Sweeney, Howard J. ; Eckhoff, Donald G. ; Nicandri, Gregg T. ; Hutchinson, Mark R. ; Johnson, Donald D. ; Bisson, Leslie J. ; Bedi, Asheesh ; Hill, James A ; Koh, Jason L. ; Reinig, Karl D. / Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator : A randomized blinded study. In: Journal of Bone and Joint Surgery - American Volume. 2014 ; Vol. 96, No. 21. pp. 1798-1806.
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abstract = "Background: 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.Methods: 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.Conclusions: 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.Clinical Relevance: 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.Results: 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.",
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Cannon, WD, Garrett, WE, Hunter, RE, Sweeney, HJ, Eckhoff, DG, Nicandri, GT, Hutchinson, MR, Johnson, DD, Bisson, LJ, Bedi, A, Hill, JA, Koh, JL & Reinig, KD 2014, 'Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator: A randomized blinded study', Journal of Bone and Joint Surgery - American Volume, vol. 96, no. 21, pp. 1798-1806. https://doi.org/10.2106/JBJS.N.00058

Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator : A randomized blinded study. / Cannon, W. Dilworth; Garrett, William E.; Hunter, Robert E.; Sweeney, Howard J.; Eckhoff, Donald G.; Nicandri, Gregg T.; Hutchinson, Mark R.; Johnson, Donald D.; Bisson, Leslie J.; Bedi, Asheesh; Hill, James A; Koh, Jason L.; Reinig, Karl D.

In: Journal of Bone and Joint Surgery - American Volume, Vol. 96, No. 21, 05.11.2014, p. 1798-1806.

Research output: Contribution to journalArticle

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T1 - Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator

T2 - A randomized blinded study

AU - Cannon, W. Dilworth

AU - Garrett, William E.

AU - Hunter, Robert E.

AU - Sweeney, Howard J.

AU - Eckhoff, Donald G.

AU - Nicandri, Gregg T.

AU - Hutchinson, Mark R.

AU - Johnson, Donald D.

AU - Bisson, Leslie J.

AU - Bedi, Asheesh

AU - Hill, James A

AU - Koh, Jason L.

AU - Reinig, Karl D.

PY - 2014/11/5

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N2 - Background: 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.Methods: 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.Conclusions: 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.Clinical Relevance: 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.Results: 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.

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