Integrating Next Generation Simulator Training and Operating Room Performance Assessment into Orthopedic Residency Programs

项目摘要/摘要 这项研究的长期目标是通过建立模拟器培训和 作为骨科住院医师计划基本组成部分的外科技能评估。许多骨科医生 手术包括将透视图像和视频解释与熟练的工具进行具有挑战性的集成 操纵以达到明确的目标。在这种情况下，模拟被证明对外科手术是有益的 实习生，但项目在接受这一进步方面进展缓慢，以及评估运营的方法 这些技能对文档改进的空间(或)表现一直欠缺。客观测量 运营部的技能是实现这一目标的关键一步，因为它允许技能培训与绩效挂钩 在手术中。这是一个重要的错失机会。拟议的研究将推进目标 测量技术是加速改善居民工作表现的关键 技术技能，最终在提高患者安全的同时降低成本。长期目标将是 通过与美国整形外科委员会(ABOS)合作实现更紧密的整合 将手术技能培训和模拟纳入认证前政策。为此，该研究所的研究人员 爱荷华大学正在利用现有ABOS拨款资助的研究小组的技能和经验 在休斯敦的罗切斯特大学和德克萨斯大学健康学院，以追求这一目标。 所提出的研究方法是基于我们的多机构模拟研究和新颖的外科手术 模拟器和我们以前由AHRQ资助的突破性分析技术，用于评估任务- 具体的、详细的或表现的。我们的中心假设是矫形外科技能能力可以 根据透视和视频中观察到的行为进行客观、定量和可靠的测量 通常在手术室收集。我们的研究团队为这项工作做好了准备；我们的核心多学科团队 近十年来，工程师、外科医生、心理测量学家一直在合作改进整形外科 住院医师培训。我们的团队现在与ABOS合作，将模拟作为一种培训工具 整形外科住院医师在获得认证资格之前进行绩效评估。建议的目标1 研究是通过对手术图像的客观分析来衡量住院医生OR表现的差异， 并加快这些测量速度。目标2是确定模拟器训练中的差异如何相互关联 并利用这些信息来改进培训计划。目标3是 找出住院医生在技能实验室和手术室中的技能差异，并使用以下方法 提高个人训练的知识水平。这项研究具有创新性，因为它论证了 传播新的技能评估技术，这是加速骨科进步的关键 驻留性能，最终在降低成本的同时提高患者安全。

Project Summary/Abstract The long-term goal of this research is to improve patient safety by establishing simulator training and evaluation of surgical skills as essential components of orthopedic residency programs. Many orthopaedic surgeries involve the challenging integration of fluoroscopic image and video interpretation with skillful tool manipulation to achieve well-defined objectives. Simulation has proved beneficial in this context for surgical trainees, but programs have been slow to embrace this advance, and methods for evaluating operating room (OR) performance of these skills to document improvement have been lacking. Objectively measuring skill in the OR is a critical step toward this goal because it allows skills training to be linked to performance in surgery. This is an important missed opportunity. The proposed research will advance objective measurement techniques that are critically needed to speed improvement in resident performance on technical skills, ultimately reducing costs while enhancing patient safety. The long-term goal will be achieved by partnering with the American Board of Orthopaedic Surgery (ABOS) to more tightly integrate surgical skills training and simulation into pre-certification policies. For this reason, researchers at the University of Iowa are leveraging the skills and experience of existing ABOS grant-funded research groups at the University of Rochester and the University of Texas Health in Houston to pursue this goal. The proposed research approach is based on our multi-institution simulation studies with novel surgical simulators and on our previous, AHRQ-funded, ground-breaking analysis techniques for assessing task- specific, detailed, OR performance. Our central hypothesis is that orthopedic surgical skill competence can be objectively, quantitatively, and reliably measured from behaviors observable in fluoroscopy and video routinely collected in the OR. Our research team is well poised for this work; our core multi-disciplinary team of engineers, surgeons, psychometricians have collaborated for nearly a decade to improve orthopedic residency training. Our team is now partnered with the ABOS to advance simulation as a tool for training orthopaedic residents and assessing performance prior to qualifying for certification. Aim 1 of the proposed research is to measure differences in resident OR performance from objective analysis of surgical imagery, and speed up these measurements. Aim 2 is to determine how differences in simulator training correlate with skills demonstrated in the OR, and use this information to improve training programs. Aim 3 is to identify individual differences in skills among residents, both in the skills lab and in the OR, and use this knowledge to improve individual training. This research is innovative because it demonstrates and disseminates new skill assessment techniques critically needed to hasten improvement in orthopedic resident performance, ultimately reducing costs while enhancing patient safety.