Simulation to Support Competency-Based Training in Orthopedic Trauma

项目概要/摘要 我们研究计划的长期目标是开发所需的科学证据，使能力- 对骨科手术技能的评价。本申请的目的是提供骨科培训 社区在三个关键发展点上具有关键骨科手术技能的科学可验证标准 在外科住院医师：准备操作，准备领导由教师监督的手术，并准备独立实践。 该项目的中心假设是，骨科手术技能能力可以客观，定量， 从影响患者安全的手术结果中可靠地测量。这一假设是基于以前的多机构 在整个中西部地区进行的模拟研究。拟议的研究探索 培训和评估计划与几个新的手术模拟器。它还将探索突破性的分析 从手术X线照片和从计算的、基于图像的、3D 模型重建该项目进一步扩大了以前的工作，以更多的居住计划和两个国家的ortho- 儿科组织：骨科创伤协会，为100多名住院医生提供培训计划， 一年几次，美国骨科医生委员会，审查900或- 每年都有许多整形外科医生，认证许多人成为ABOS的官方认证。 这些国家组织提供了大量潜在的研究参与者， 为实现令人兴奋的新研究目标创造了机会，包括这三个具体目标。具体目标1是 通过手术结果衡量创伤骨科手术技能。这一目标的工作假设是， 通过分析与手术相关的射线照相图像，可以测量整形外科创伤中的外科技能。具体 目标2是开发基于模拟器的培训计划，以提高手术效果。工作假设是， 练习关键技能直到达到熟练程度的住院医师在手术室中的表现比具有以下技能的住院医师更好- 出去训练。具体目标3是定义基于模拟器的评估，以推广到临床性能。的 工作假设是模拟器评估测量将区分手术技能水平， 还可以在手术任务以及模拟和临床实践之间进行概括。 这项研究将为骨科医生提供一个安全的环境，以获得宝贵的经验 而不会让病人处于危险之中。它还将有助于建立可靠的临床性能能力指标， 他们的潜在用途的资格和认证。最后，随着新的模拟能力在 今后几年，这项工作将成功地指明从发展到改变实践的道路。

Project Summary/Abstract The long-term goal of our research program is to develop the scientific evidence needed to bring competency- based evaluation of surgical skills to orthopedics. The objective of this application is to provide the orthopedic training community with scientifically defendable criteria for critical orthopedic surgical skills at three key developmental points in surgical residency: ready to operate, ready to lead a surgery supervised by faculty, and ready for independent practice. The central hypothesis of this project is that orthopedic surgical skill competence can be objectively, quantitatively, and reliably measured from surgical results that impact patient safety. This hypothesis is based on previous multi-institutional simulation studies conducted with residency programs throughout the Midwest region. The proposed research explores training and assessment programs with several novel surgical simulators. It will also explore ground-breaking analysis techniques for assessing operating room performance from surgical radiographs and from computational, image-based, 3D model reconstruction. This project further expands previous work to more residency programs and to two national ortho- pedic organizations: the Orthopedic Trauma Association, which offers training programs to over a hundred residents sev- eral times a year, and to the American Board of Orthopedic Surgeons, which reviews the credentials and skills of 900 or- thopedic surgeons each year, certifying many to become official diplomates of ABOS. The participation of these national organizations, which provide a large number of potential research participants, creates the opportunity for achieving exciting new research goals, including these three specific aims. Specific Aim 1 is to measure orthopedic trauma surgery skill through surgical results. The working hypothesis for this aim is that sur- gical skill in orthopedic trauma can be measured by analyzing radiographic images associated with a surgery. Specific Aim 2 is to develop simulator-based training programs that improve surgical results. The working hypothesis is that residents who practice key skills until achieving proficiency will perform better in the operating room than residents with- out training. Specific Aim 3 is to define simulator-based assessments that generalize to clinical performance. The working hypothesis is that simulator assessment measurements will discriminate among levels of surgical skill and will also generalize across surgical tasks and between simulation and clinical practice. The proposed research will provide a safe environment for orthopedic surgeons to acquire valuable experience without putting patients at risk. It will also help to establish reliable measures of clinical performance competency and their potential use for credentialing and certification. Finally, as new simulation capabilities become available over the ensuing years, this work will have successfully shown the way from development to changing practice.