Improving Resident Performance in Knee Arthroscopy A Prospective Value Assessment of Simulators and Cadaveric Skills Laboratories
Improving Resident Performance in Knee Arthroscopy A Prospective Value Assessment of Simulators and Cadaveric Skills Laboratories
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DOI：
10.2106/jbjs.o.00440
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发表时间：
2016-02-03
影响因子：
5.3
通讯作者：
Turner, Norman S.
中科院分区：
文献类型：
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作者：
Camp, Christopher L.;Krych, Aaron J.;Turner, Norman S.
背景：身体技能实验室和虚拟现实模拟器是在手术室外常用的两种方法，以提高住院医生的膝关节镜检查能力。我们不知道这两种方法的教育价值有任何正面的比较。这项前瞻性随机试验的目的是评估这些培训方法的有效性，比较它们的改善率，并为寻求实施此类技术的项目提供经济价值数据。方法：骨科住院医师随机分为三组：对照组、身体上培训(身体组)和使用模拟器进行培训(模拟器组)。居民在身体上完成了测试前和测试后的诊断性膝关节镜检查，并进行了计时和录像。在前后测之间，对照组不做关节镜检查，身体组在身体上练习4小时，模拟器组在模拟器上训练4小时。使用经过验证的关节镜手术技能评估工具(ASSET)对所有测试进行盲法、随机化评分。结果：45名住院医生(每组15名)完成了研究。实验前后资产评分的平均差值：对照组为-0.4(p=0.776)，身体组为+4.27(p=0.002)，模拟器组为+1.92(p=0.096)(组间比较p=0.015)。实验前后测试完成时间(分：秒)：对照组为0：07(p=0.902)，身体组为3：01(p=0.002)，模拟器组为0：28(p=0.708)(组间比较p=0.044)。身体组住院医师平均每小时训练提高1.1个资产点，模拟器组平均每小时培训提高0.5个资产点。结论：身体技能实验室提高了住院医师膝关节镜检查成绩。在身体标本上练习的居民的进步速度是使用高保真模拟器的两倍；然而，根据我们机构的具体成本估计，如果模拟器每年至少使用300个小时，可能会更具成本效益。有必要对这种可能性进行更多的研究。
Background: Cadaveric skills laboratories and virtual reality simulators are two common methods used outside of the operating room to improve residents' performance of knee arthroscopy. We are not aware of any head-to-head comparisons of the educational values of these two methodologies. The purpose of this prospective randomized trial was to assess the efficacy of these training methods, compare their rates of improvement, and provide economic value data to programs seeking to implement such technologies.Methods: Orthopaedic surgery residents were randomized to one of three groups: control, training on cadavera (cadaver group), and training with use of a simulator (simulator group). Residents completed pretest and posttest diagnostic knee arthroscopies on cadavera that were timed and video-recorded. Between the pretest and posttest, the control group performed no arthroscopy, the cadaver group performed four hours of practice on cadavera, and the simulator group trained for four hours on a simulator. All tests were scored in a blinded, randomized fashion using the validated Arthroscopy Surgical Skill Evaluation Tool (ASSET). The mean improvement in the ASSET score and in the time to complete the procedure were compared between the pretest and posttest and among the groups.Results: Forty-five residents (fifteen per group) completed the study. The mean difference in the ASSET score from the pretest to the posttest was -0.40 (p = 0.776) in the control group, +4.27 (p = 0.002) in the cadaver group, and +1.92 (p = 0.096) in the simulator group (p = 0.015 for the comparison among the groups). The mean difference in the test-completion time (minutes: seconds) from the pretest to the posttest was 0: 07 (p = 0.902) in the control group, 3: 01 (p = 0.002) in the cadaver group, and 0: 28 (p = 0.708) in the simulator group (p = 0.044 for the comparison among groups). Residents in the cadaver group improved their performance at a mean of 1.1 ASSET points per hour spent training whereas those in the simulator group improved 0.5 ASSET point per hour of training.Conclusions: Cadaveric skills laboratories improved residents' performance of knee arthroscopy compared with that of matched controls. Residents practicing on cadaveric specimens improved twice as fast as those utilizing a high-fidelity simulator; however, based on cost estimation specific to our institution, the simulator may be more cost-effective if it is used at least 300 hours per year. Additional study of this possibility is warranted.