Simulation to Support Competency-Based Training in Orthopedic Trauma

项目摘要/摘要 我们研究计划的长期目标是开发所需的科学证据，以带来能力- 基于骨科手术技能的评估。此应用程序的目标是提供整形外科培训 在三个关键发展点为关键的整形外科手术技能制定科学可预防的标准的社区 外科住院医师：准备手术，准备领导由教员监督的手术，并准备独立执业。 该项目的中心假设是矫形外科技能能力可以客观地、定量地和 从影响患者安全的手术结果中可靠地衡量。这一假设是基于之前的多机构 对整个中西部地区的常驻项目进行了模拟研究。拟议的研究探索了 使用几种新型手术模拟器的培训和评估计划。它还将探索开创性的分析 从外科X线片和计算的、基于图像的、3D的评估手术室性能的技术 模型重建。该项目将以前的工作进一步扩展到更多的住院医师计划和两个国家矫形外科- 儿科组织：整形外科创伤协会，它为100多名住院医生提供培训计划。 一年几次，并提交给美国整形外科医生委员会，该委员会审查900名或- 每年都有整形外科医生，认证许多人成为ABOS的官方文凭。 这些国家组织的参与提供了大量潜在的研究参与者， 为实现令人振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 通过手术结果来衡量骨科创伤手术技巧。实现这一目标的可行假设是： 骨科创伤的外科技能可以通过分析与手术相关的放射图像来衡量。特定的 目标2是开发基于模拟器的培训计划，以改善手术结果。工作假说是 练习关键技能直到熟练掌握的住院医生在手术室的表现会比有以下情况的住院医生更好- 外出训练。具体目标3是定义基于模拟器的评估，以概括临床表现。这个 工作假设是，模拟器评估测量将区分手术技能和意志的水平 也可以在外科手术任务以及模拟和临床实践之间进行推广。 拟议的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表现能力衡量标准和 它们可能用于认证和认证。最后，随着新的模拟功能在 在接下来的几年里，这项工作将成功地展示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.