Improving Patient Safety in Orthopaedic Trauma Surgical Training

项目摘要/摘要 矫形外科技能很大程度上是通过在手术室(OR)当学徒来获得的。 这种昂贵而无情的培训模式难以确保患者的安全。长期目标 这项工作的目的是通过提供有效的模拟工具来改善患者的安全性和预后。这项工作 意义重大，因为它将提供严格的科学证据，证明手术模拟器可以改善 骨科住院医师的OR表现。骨科住院医生学习的一项常见而重要的技能 就是沿着骨头内的精确路径驱动一根锋利的不锈钢钉子。这项任务通常称为 钢丝导航，是治疗许多常见骨折的一部分。这项任务需要外科医生依靠2D 透视成像以评估骨骼内钢丝的进展情况。精确控制的位置 钢丝对患者的安全和固定强度至关重要。已经开发了一种模拟导线的模拟器 导航在骨科最常见的手术之一：固定近端骨折 大腿骨。增强现实模拟器将真实的钻头和代理股骨与计算机生成的 透视图像。模拟器紧密地复制了在OR中钻孔的感觉，同时保持 无辐射训练环境的好处。任务完成后由以下人员评估任务绩效 测量几个重要的量，同样可以在OR中直接测量。 拟议研究的具体目标是衡量使用新的 用于培训住院医生有线导航的模拟器。中心假设是模拟器复制 实际有线导航的关键要素。将实现以下目标。目标1：演示如何 刻意练习可以提高有线导航性能。涉及近几年的多机构研究 将对300名骨科实习医生进行测试，以测量获取钢丝的学习曲线 无辐射模拟器的导航技能。在进入破产管理处之前，将进行研究 为了证明模拟器性能提高了涉及实际操作的手术模拟的性能 透视检查。目标2：证明模拟器性能与OR中的性能相关。其他内容 将进行研究，以证明使用模拟器进行的技能评估区分初级 骨科住院医生由老年住院医生组成。将进行更多研究，以确定 模拟器上的性能与OR性能相关。拟议的一系列研究链接 在技能实验室进行培训和评估，以达到在手术室的表现。这为发展， 测试和改进矫形外科手术中的模拟器。一支经验丰富的研究团队已经 一个商业合作伙伴准备促进模拟器的更广泛传播。增加了 在手术室外获得的有线导航常住技能将使患者避免不必要的额外风险， 导致更快的程序，产生更好的手术结果，并最终提供更好的患者结果。

Project Summary / Abstract Orthopaedic surgical skills are largely acquired through apprenticeship in the operating room (OR). This expensive and unforgiving training model struggles to ensure patient safety. The long-term goal of this work is to improve patient safety and outcomes by providing effective simulation tools. The work is significant in that it will provide rigorous scientific evidence that a surgical simulator can improve an orthopaedic resident's OR performance. A common and important skill that orthopaedic residents learn is to drive a sharpened stainless steel pin along a precise path within bone. This task, commonly called wire navigation, is a part of treating many common fractures. The task requires surgeons to rely on 2D fluoroscopic imaging to assess progress of the wire within the bone. Precisely controlling the position of the wire is critical to patient safety and fixation strength. A simulator has been developed to mimic wire navigation in one of the most common surgeries in orthopaedics: the fixing of a fracture of the proximal femur. The augmented reality simulator blends a real drill and surrogate femur with computer-generated fluoroscopic images. The simulator closely replicates the sensation of drilling in the OR while retaining the benefit of a radiation-free training environment. Task performance is assessed upon completion by measuring several important quantities, which can likewise be directly measured in the OR. The specific objective of the proposed research is to measure the effectiveness of using the new simulator to train residents in wire navigation. The central hypothesis is that the simulator reproduces critical elements of actual wire navigation. The following aims will be pursued. Aim 1: Demonstrate how deliberate practice improves wire navigation performance. Multi-institutional studies involving nearly 300 orthopaedic residents will be undertaken to measure the learning curve for acquiring wire navigation skill on the radiation-free simulator. Prior to progressing to the OR, studies will be conducted to show that simulator performance improves performance on a surgical simulation involving actual fluoroscopy. Aim 2: Show that simulator performance correlates with performance in the OR. Additional studies will be conducted to demonstrate that skill assessments with the simulator distinguish junior orthopaedic residents from senior residents. Additional studies will be conducted to determine if performance on the simulator correlates with OR performance. The proposed series of studies link training and assessment in the skills lab to performance in the OR. This paves the way for developing, testing, and improving simulators within orthopaedic surgery. An experienced research team has been assembled, and a commercial partner is ready to foster wider dissemination of the simulator. Increased resident skill in wire navigation gained outside of the OR will spare patients unnecessary additional risk, lead to faster procedures, yield better surgical results, and ultimately provide better patient outcomes.