High-Fidelity Orthopaedic Surgical Skills Models and Resident Performance in the Surgical Treatment of Tibial Plateau Fractures (1090-002354) (Research Abstract Professor Rounds: Group 2)
Start time: Thursday, January 28, 2021, 10:00 AM End time: Thursday, January 28, 2021, 11:00 AM Session Type: Research Abstracts (Completed Studies)
There is a gap between the skills required of an orthopaedic surgeon and resident opportunities to practice such skills in a realistic setting (1-3). A survey conducted in 2013 of 86 U.S. orthopaedic surgery residency program directors and 687 residents found 80% of program directors and 86% of residents believed surgical technique simulation should be implemented in residency training (2,4). However, evaluation of performance on such simulations has proven to be difficult: the same survey found that 58% of program directors and 83% of residents felt surgical skill in simulation was not objectively measured (2,4). The use of low-fidelity Sawbones models in resident training has become commonplace but scant data exists measuring how the use of these models translates to the skills required in higher fidelity simulations and real world procedures. The purpose of this study was to quantify the impact of low-fidelity simulation on resident surgical skills education.
The study protocol was approved by the Naval Medical Center Portsmouth Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Fourteen orthopaedic surgery residents (PGY-1 through PGY-5) were separated into two, training-level-matched cohorts – an untrained control cohort (UCC) and a low-fidelity Sawbones training cohort (SAW). Together, both cohorts received didactic instruction from ABOS-certified orthopaedic trauma surgeons on Schatzker II tibial plateau fractures. The SAW group first rehearsed open-reduction, internal-fixation once on radiopaque Sawbones models (Pacific Research Laboratories Inc. Vashon, WA). Both cohorts were then evaluated while performing the same procedure on high-fidelity cadaveric models (Rimasys GmbH Cologne, Germany). Surgical skill and knowledge were assessed using the objective structured assessment of technical skills (OSATS) tool, a written exam, and an after-action survey.
The mean overall OSATS score out of a possible 35 was 20.29 (range 10-33) in the UCC cohort and 22.71 (range 11-33) in the SAW cohort. While no statistically significant differences were seen between in average overall OSATS scores (p=0.62) or scores for any particular parameter, a near-linear positive relationship (R2=0.9737) existed between training year and average overall OSATS score. Additionally, no significant difference was seen between the written exam scores of the two cohorts (p=0.22). After performing the surgery on high-fidelity cadavers, 100% of the subjects felt better prepared to perform this procedure. All study participants did note in their after-action surveys that they felt using high-fidelity cadaveric models in a training environment prepared them for real-world performance better than using low-fidelity Sawbones models alone.
The results of this study fail to demonstrate an advantage when training with Sawbones low-fidelity models prior to evaluation of surgical skill using high-fidelity cadaveric models. However, the study did demonstrate the value of high-fidelity models in resident education. Despite similar outcomes in practical evaluation of surgical skill following different training interventions, residents across both cohorts qualitatively felt the high-fidelity models offered a better educational opportunity for surgical practice than did the low-fidelity models. Many residents asked that this exercise be performed for other surgical procedures as it offers realistic training outside of the operating room environment. Continued work should consider the aforementioned error modes to better define significant differences between the training interventions employed. Future work comparing the impact of low-fidelity and high-fidelity training models on surgical skill is warranted.