A team of University of Iowa researchers studied 55 residents from four medical centers in order to determine whether simulator-based wire navigation training can transfer to higher-level tasks.
Their work, “Do Skills Acquired from Training with a Wire Navigation Simulator Transfer to a Mock Operating Room Environment?” appears in the May 17, 2019 edition of Clinical Orthopaedics and Related Research.
Co-author Donald D. Anderson, Ph.D., director of the Orthopaedic Biomechanics Laboratory at the University of Iowa explained the genesis of this study to OTW, “Orthopaedic residents can struggle with fluoroscopic wire navigation skills when they first enter the operating room (OR). A lack of training opportunities outside of the OR may create an unnecessary patient safety risk and yield inferior results during a resident’s first opportunity to perform this task during surgery.”
To tackle this question, the Iowa researchers divided residents into three groups:
- traditional training,
- deliberate practice, and
- proficiency training.
Residents in each group received traditional training (didactic training regarding placement on a wire to treat an intertrochanteric fracture).
Residents who received “deliberate practice” were trained on a radiation-free simulator which provided each resident with specific feedback.
Residents who received “proficiency training” were also trained on a radiation-free simulator but also received training on specific components of wire navigation, such as locating the correct starting point, to proficiency before moving to assessment.
Dr. Anderson summarized his findings to OTW, “Orthopaedic residents who train on a radiation-free hip fracture wire navigation simulator that replicates the look and feel of driving a wire through bone using fluoroscopic guidance demonstrate improved performance on a simulated surgery involving actual C-arm fluoroscopy in a mock OR.”
“The principal surgical measure of effectiveness, the tip apex distance, was specifically improved after training. Also, performance on the simulator was found to correlate with performance in the mock OR. Finally, our results indicate that the simulator has potential to be used as an assessment tool for wire navigation skills.”
“While some skills are best learned in the OR, orthopaedic residents can enter the OR with improved skill if they first go through a validated simulation training that targets the development of specific skills. A structured simulator curriculum can facilitate deliberate practice supported by immediate, objective feedback and assessment. This underscores the fact that providing residents with a dedicated time and space for practice is key to having higher performing residents.”
“A huge part of orthopaedic surgery is using tools and feeling how they interact with bone. Although virtual reality simulators have lots to offer, our belief is that having this realistic tactile feedback is essential to learning.”
“Also, the ability to automatically and objectively score performance on a simulator is particularly beneficial to learners (and potentially certifying bodies). Residents want to know how they are doing. If they are struggling with a skill, they want an environment in which to practice that skill. This will allow residents to safely improve their skills, learning from mistakes long before entering the OR.”
