Original Article
Arthroscopic Training Courses Improve Trainee Arthroscopy Skills: A Simulation-Based Prospective Trial

https://doi.org/10.1016/j.arthro.2016.03.026Get rights and content

Purpose

To evaluate the correlation between timed task performance on an arthroscopy shoulder simulator and participation in a standardized expert shoulder arthroscopy educational course.

Methods

Orthopaedic trainees were voluntarily recruited from over 25 residency programs throughout the United States and Canada. Each trainee was tested on arrival at the Arthroscopy Association of North America orthopaedic learning center on a virtual reality arthroscopy shoulder simulator, and his or her performance was objectively scored. Each trainee's postgraduate year level was recorded, as was his or her experience in residency with shoulder arthroscopy as measured by Accreditation Council for Graduate Medical Education case-log totals. After the focused 4-day training curriculum consisting of didactics and cadaveric experience, each trainee was re-evaluated on the same simulator. Statistical analysis was performed to determine if participation in the course was associated with changes in simulation performance from before to after assessment.

Results

Forty-eight trainees completed the testing. On completion of the course, trainees showed significant improvements in all objective measures recorded by the simulator. Total probe distance needed to complete the task decreased by 42% (from 420.4 mm to 245.3 mm, P < .001), arthroscope tip distance traveled decreased by 59% (from 194.1 mm to 80.2 mm, P < .001), and time to completion decreased by 38% (from 66.8 seconds to 41.6 seconds, P < .001). Highly significant improvements in all 3 measures suggest improved instrument handling, anatomic recognition, and arthroscopy-related visual-spatial ability.

Conclusions

This study shows objective improvement in orthopaedic trainee basic arthroscopy skill and proficiency after a standardized 4-day arthroscopy training curriculum. The results validate the Arthroscopy Association of North America resident training course and its curriculum with objective evidence of benefit.

Level of Evidence

Level III, prospective study of nonconsecutive participants.

Section snippets

Participants

After institutional review board approval, 99 orthopaedic surgery trainees of various postgraduate years (PGYs) were invited to participate in this study between October 2013 and June 2014. There were 3 courses during this time, and because of simulator availability limitations, the first and last courses were evaluated. Participants were from throughout North America and included over 20 different American programs and 3 Canadian programs. All trainees were contacted before arrival at the

Results

Ninety-nine trainees enrolled in the courses. Eight-four attended every day of the course. Forty-eight trainees completed both sets of testing. The study group of orthopaedic trainees consisted of 40 men and 8 women. The study group comprised one PGY-1 trainee, six PGY-2 trainees, thirty-two PGY-3 trainees, six PGY-4 trainees, and three PGY-5 trainees, with shoulder arthroscopy case logs ranging from 0 to 215, with a median of 31 (interquartile range, 34). A summary of demographic information

Discussion

Our study found that after participation in the AANA resident arthroscopy skills course, orthopaedic trainees showed significant improvements in all measures recorded by a VR arthroscopy simulator. This includes the distance traveled by the arthroscopic probe, the distance traveled by the arthroscope, and the time to completion. This standardized curriculum, consisting of didactics, box trainers, and instructor-led hands-on cadaveric experience, was followed immediately by improved basic

Conclusions

This study shows objective improvement in orthopaedic trainee basic arthroscopy skill and proficiency after a standardized 4-day arthroscopy training curriculum. The results validate the AANA resident training course and its curriculum with objective evidence of benefit.

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The authors report the following potential conflict of interest or source of funding: K.D.M. receives support from Department of Defense, US Army. This project was supported by an educational grant from the Arthroscopic Association of North America and has not been presented.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or the US government. The authors are employees of the US government.

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