2015 ISAKOS Biennial Congress ePoster #314

A Validated Orthopaedic Surgical Simulation Model for Training and Evaluation of Basic Arthroscopic Skills

Ryan Coughlin, MD, Beaconsfield, QC CANADA
Thierry Pauyo, MD, FRCSC, Montreal, QC CANADA
Joseph Carl Sutton III, MD, Peachtree City, GA CANADA
Larry Coughlin, MD, FRCS(C), Montreal, Quebec CANADA
Stephane Bergeron, MD, MPH, FRCS(C), Montreal, Quebec CANADA
McGill University, Montreal, Quebec, CANADA

FDA Status Not Applicable

Summary: An arthroscopic training box model was successfully designed showing good construct validity and significant improvement in performance according to level of training.

Abstract:

Introduction

There is currently no validated educational model to evaluate and teach
basic arthroscopic skills that is widely accessible to orthopaedic residency training
programs. The primary objective was to design and validate a surgical simulation
model by showing that subjects with increasing level of training perform better on basic
arthroscopic simulation tasks. The secondary objective was to evaluate inter-rater and
intra-rater reliability of the model.

Methods

A nominal group technique was used to design an arthroscopic simulation skills model. Prospectively recruited participants were divided by level of training into
four groups. Subjects performed six basic arthroscopic tasks using a box model: 1)
probing, 2) grasping, 3) tissue resection, 4) shaving, 5) tissue liberation and suture
passing, and 6) knot tying. A score was calculated according to time required to
complete each task and deductions for technical errors. A priori total global score out of
a possible 100 points was calculated by averaging scores from all six tasks using equal
weights. The grading was done by blinded reviewers.

Results

A total of 49 participants were recruited for this study: Group 1 (novice: 15
medical students and interns), Group 2 (junior residents: 12 PGY2-3 residents), Group
3 (senior residents: 16 PGY4-5 residents) and Group 4 (6 arthroscopic surgeons). The
mean total global score differed significantly between groups (p<0.001): Group 1= 29
(± 13.6); Group 2= 40.3 (± 12.1); Group 3= 57.6 (± 7.4); and Group 4= 72.4 (± 3.0).
Pairwise comparison with Tukey correction confirmed construct validity by showing
significant improvement in overall performance by increasing level of training between
all groups. The model proved to be highly reliable with an intraclass correlation
coefficient of 0.99 for both inter-rater and intra-rater reliability.

Conclusions

A simulation model was successfully designed to teach and evaluate
basic arthroscopic skills showing good construct validity. This arthroscopic simulation
model is inexpensive, valid and reliable, and has the potential to be implemented in
other training programs.