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Cost-effective surgical training simulator combines accessible supplies, quick setup
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With the Accreditation Council for Graduate Medical Education requiring all post-graduate year 1 orthopedic surgery residents to undergo formal surgical skills training, simulator development in residency is a major focus of attention. The goal of simulator training is to objectively enable trainees to develop surgical motor skills that will promote the delivery of safe and high-quality patient care.
Fundamental surgical skills such as fracture reduction, hardware fixation and wound closure are essential for residents and practicing orthopedic surgeons. However, the hand-eye coordination and dexterity required to adequately perform these tasks is demanding, and therefore, hours of practice are necessary to noticeably improve the skills of an inexperienced surgeon. With the impact of an 80-hour work week, the practice of surgical skills will require a consistent effort outside of the operating room.
Simulators
Residency training now has to evolve and adapt modern technology, and simulators are a critical component to the acquisition of necessary surgical skills. While a variety of simulator modalities such as synthetic bone exercises, cadavers and virtual reality devices, are effective, these methods are often accompanied by high costs and lengthy setup and use time.
This UC-Irvine orthopedic training simulator incorporates skills such as fracture reduction, 3-D drilling, fluoroscopic drilling and suture closure.
Image: Hsu AR
At the American Academy of Orthopedic Surgeons (AAOS) Annual Meeting, the University of California-Irvine (UC-Irvine) won the Best Scientific exhibit award for their project “Cost-effective training and assessment simulators for orthopaedic surgical skills.” The investigators developed and validated a cost-effective psychomotor training and assessment tool for orthopedic resident education known as The Fundamentals of Orthopaedic Surgery (FORS).
“I drew upon my past experiences from playing baseball. I initially learned how to play by performing simple motor movements intrinsic to the sport with high repetitions in a short amount of time. [I] thought that this type of training could be applicable to some of the movements we perform during orthopedic procedures,” Gregory Lopez, MD, an orthopedic surgery resident and lead author for the project, told Orthopedics Today.
With a total cost of $340 and 2 hour average setup time, the training simulator allows learners to practice a variety of motor skills.
Materials for the simulator are low-cost, reusable and available at hardware stores. The testable surgical skills using the multi-station simulator include fracture reduction, 3-D drilling, fluoroscopic drilling, depth of plunge minimization, drill by feel and suture closure. The simulator has been tested at three Accreditation Council for Graduate Medical Education accredited orthopedic surgery residency programs.
Initial testing
Scores based on ability to successfully and independently complete a task were tabulated for all six simulator skills among medical students, junior vs. senior residents and attendings, and showed consistently higher scores among more experienced surgeons. To determine whether their simulator could improve surgical skills, the UC-Irvine team held weekly training labs with initial testing followed by 15 minutes of training. After four sessions, a fifth exam occurred 4 weeks later to test retention. Noives improved to near or above junior level resident scores.
“Most programs do not have large disposable incomes for surgical simulation. Therefore, each training tool must be critically evaluated to determine if it will be maximally beneficial to residents. Similar to Fundamentals of Laparoscopic Surgery that our general surgery colleagues use, our FORS simulator may become an integral training tool, as it reproduces basic orthopedic operative movements with nominal financial investment from programs,” Ranjan Gupta, MD, chair of the UC-Irvine Department of Orthopaedic Surgery and project principal investigator, said.
Simulators are likely to play a substantial role in enabling the successful development of technical skills in orthopedic residency programs. While the operative translatability of simulators is unknown, the work by UC-Irvine represents a major step toward the creation of a widely accessible and testable educational tool for future orthopedic surgeons.
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Andrew R. Hsu, MD, is a fifth-year resident at Rush University Medical Center in Chicago. He is also co-editor of the Rush Grand Rounds column for Orthopedics Today.
Disclosures: Lopez has no relevant financial disclosures. Gupta is on the speakers bureau for Arthrex Inc. and Synthes; receives research support from Arthrex Inc., Smith & Nephew, Synthes, Medartis and SpineArt; receives royalties from McGraw.