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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-01-2014 | Sports Medicine

The internal validity of arthroscopic simulators and their effectiveness in arthroscopic education

Authors: Jesse Alan Slade Shantz, Jeff R. S. Leiter, Tania Gottschalk, Peter Benjamin MacDonald

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2014

Abstract

Purpose

The purpose of this systematic review was to identify standard procedures for the validation of arthroscopic simulators and determine whether simulators improve the surgical skills of users.

Methods

Arthroscopic simulator validation studies and randomized trials assessing the effectiveness of arthroscopic simulators in education were identified from online databases, as well as, grey literature and reference lists. Only validation studies and randomized trials were included for review. Study heterogeneity was calculated and where appropriate, study results were combined employing a random effects model.

Results

Four hundred and thirteen studies were reviewed. Thirteen studies met the inclusion criteria assessing the construct validity of simulators. A pooled analysis of internal validation studies determined that simulators could discriminate between novice and experts, but not between novice and intermediate trainees on time of completion of a simulated task. Only one study assessed the utility of a knee simulator in training arthroscopic skills directly and demonstrated that the skill level of simulator-trained residents was greater than non-simulator-trained residents.

Conclusions

Excessive heterogeneity exists in the literature to determine the internal and transfer validity of arthroscopic simulators currently available. Evidence suggests that simulators can discriminate between novice and expert users, but discrimination between novice and intermediate trainees in surgical education should be paramount. International standards for the assessment of arthroscopic simulator validity should be developed to increase the use and effectiveness of simulators in orthopedic surgery.

Level of evidence

Diagnostic study, Level III.

Available only for authorised users

Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA III, Ramel S, Smith CD, Arvidsson D (2007) Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 193(6):797–804PubMedCrossRef

Atesok K, Mabrey JD, Jazrawi LM, Egol KA (2012) Surgical simulation in orthopaedic skills training. J Am Acad Orthop Surg 20(7):410–422PubMedCrossRef

Babineau TJ, Becker J, Gibbons G, Sentovich S, Hess D, Robertson S, Stone M (2004) The “cost” of operative training for surgical residents. Arch Surg 139(4):366–369PubMedCrossRef

Barnes RW (1987) Surgical handicraft: teaching and learning surgical skills. Am J Surg 153(5):422–427PubMedCrossRef

Berwick DM, Leape LL (1999) Reducing errors in medicine. BMJ 319(7203):136–137PubMedCrossRef

Bridges M, Diamond DL (1999) The financial impact of teaching surgical residents in the operating room. Am J Surg 177(1):28–32PubMedCrossRef

Cannon WD, Eckhoff DG, Garrett WE Jr, Hunter RE, Sweeney HJ (2006) Report of a group developing a virtual reality simulator for arthroscopic surgery of the knee joint. Clin Orthop Relat Res 442:21–29PubMedCrossRef

Ceponis PJ, Chan D, Boorman RS, Hutchison C, Mohtadi NG (2007) A randomized pilot validation of educational measures in teaching shoulder arthroscopy to surgical residents. Can J Surg 50(5):387–393PubMedCentralPubMed

Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165(1):9–14PubMedCrossRef

10.

Farnworth LR, Lemay DE, Wooldridge T, Mabrey JD, Blaschak MJ, DeCoster TA, Wascher DC, Schenck RC Jr (2001) A comparison of operative times in arthroscopic ACL reconstruction between orthopaedic faculty and residents: the financial impact of orthopaedic surgical training in the operating room. Iowa Orthop J 21:31–35PubMedCentralPubMed

11.

Gomoll AH, O’Toole RV, Czarnecki J, Warner JJ (2007) Surgical experience correlates with performance on a virtual reality simulator for shoulder arthroscopy. Am J Sports Med 35(6):883–888PubMedCrossRef

12.

Gomoll AH, Pappas G, Forsythe B, Warner JJ (2008) Individual skill progression on a virtual reality simulator for shoulder arthroscopy: a 3-year follow-up study. Am J Sports Med 36(6):1139–1142PubMedCrossRef

13.

Hariri S, Rawn C, Srivastava S, Youngblood P, Ladd A (2004) Evaluation of a surgical simulator for learning clinical anatomy. Med Educ 38(8):896–902PubMedCrossRef

14.

Howells NR, Brinsden MD, Gill RS, Carr AJ, Rees JL (2008) Motion analysis: a validated method for showing skill levels in arthroscopy. Arthroscopy 24(3):335–342PubMedCrossRef

15.

Howells NR, Gill HS, Carr AJ, Price AJ, Rees JL (2008) Transferring simulated arthroscopic skills to the operating theatre: a randomised blinded study. J Bone Joint Surg Br 90(4):494–499PubMedCrossRef

16.

Insel A, Carofino B, Leger R, Arciero R, Mazzocca AD (2009) The development of an objective model to assess arthroscopic performance. J Bone Joint Surg Am 91(9):2287–2295PubMedCrossRef

17.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12PubMedCrossRef

18.

James PB, Hope SH-B, Mark WS (2005) Determining the efficacy of an immersive trainer for arthroscopy skills. In: MMVR13, Amsterdam, Netherlands, 1999. Medicine meets virtual reality. The magical next becomes the medical now. IOS press, pp 54–56

19.

Kauvar DS, Braswell A, Brown BD, Harnisch M (2006) Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy. J Surg Res 132(2):159–163PubMedCrossRef

20.

Mabrey JD, Reinig KD, Cannon WD (2010) Virtual reality in orthopaedics: is it a reality? Clin Orthop Relat Res 468:2586–2591PubMedCrossRef

21.

McCarthy A, Harley P, Smallwood R Virtual arthroscopy training: do the virtual skills developed match the real skills required? In: MMVR 7, Amsterdam, Netherlands, 1999. Medicine meets virtual reality. Convergence of physical and informational technologies: Options for a New Era in Healthcare. IOS Press, pp 221–227

22.

McCarthy AD, Moody L, Waterworth AR, Bickerstaff DR (2006) Passive haptics in a knee arthroscopy simulator: is it valid for core skills training? Clin Orthop Relat Res 442:13–20PubMedCrossRef

23.

Megali G, Tonet O, Mazzoni M, Dario P, Vascellari A, Marcacci M (2002) A new tool for surgical training in knee arthroscopy. In: Proceedings of the part II, Berlin, Germany, 2002. Medical image computing and computer-assisted intervention—MICCAI 2002. 5th international conference. Springer, pp 170–177

24.

Modi CS, Morris G, Mukherjee R (2010) Computer-simulation training for knee and shoulder arthroscopic surgery. Arthroscopy 26(6):832–840PubMedCrossRef

25.

Moorthy K, Munz Y, Sarker SK, Darzi A (2003) Objective assessment of technical skills in surgery. BMJ 327(7422):1032–1037PubMedCrossRef

26.

Pedowitz RA, Esch J, Snyder S (2002) Evaluation of a virtual reality simulator for arthroscopy skills development. Arthroscopy 18(6):E29PubMedCrossRef

27.

Review Manager (RevMan) [Computer program] (2011) Version 5.1. Copenhagen: The Nordic Cochrane Centre, The cochrane collaboration

28.

Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 340:c332PubMedCentralPubMedCrossRef

29.

Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236(4):458–463PubMedCrossRef

30.

Sherman KP, Ward JW, Wills DP, Sherman VJ, Mohsen AM (2001) Surgical trainee assessment using a VE knee arthroscopy training system (VE-KATS): experimental results. Stud Health Technol Inform. 81:465–470PubMed

31.

Sidhu RS, Park J, Brydges R, MacRae HM, Dubrowski A (2007) Laboratory-based vascular anastomosis training: a randomized controlled trial evaluating the effects of bench model fidelity and level of training on skill acquisition. J Vasc Surg 45(2):343–349PubMedCrossRef

32.

Smith S, Wan A, Taffinder N, Read S, Emery R, Darzi A (1999) Early experience and validation work with Procedicus VA—the Prosolvia virtual reality shoulder arthroscopy trainer. Studies In Health Technology And Informatics 62:337–343PubMed

33.

Srivastava S, Youngblood PL, Rawn C, Hariri S, Heinrichs WL, Ladd AL (2004) Initial evaluation of a shoulder arthroscopy simulator: establishing construct validity. J Shoulder Elbow Surg 13(2):196–205PubMedCrossRef

34.

Strom P, Kjellin A, Hedman L, Johnson E, Wredmark T, Fellander-Tsai L (2003) Validation and learning in the Procedicus KSA virtual reality surgical simulator. Surg Endosc 17(2):227–231PubMedCrossRef

35.

Strom P, Kjellin A, Hedman L, Wredmark T, Fellander-Tsai L (2004) Training in tasks with different visual-spatial components does not improve virtual arthroscopy performance. Surg Endosc 18(1):115–120PubMedCrossRef

36.

Tashiro Y, Miura H, Nakanishi Y, Okazaki K, Iwamoto Y (2009) Evaluation of skills in arthroscopic training based on trajectory and force data. Clin Orthop Relat Res 467(2):546–552PubMedCrossRef

37.

Tuijthof GJM, van Sterkenburg MN, Sierevelt IN, van Oldenrijk J, Van Dijk CN, Kerkhoffs GMMJ (2010) First validation of the PASSPORT training environment for arthroscopic skills. Knee Surg Sports Traumatol Arthrosc 18(2):218–224PubMedCrossRef

Title: The internal validity of arthroscopic simulators and their effectiveness in arthroscopic education
Authors: Jesse Alan Slade Shantz
Jeff R. S. Leiter
Tania Gottschalk
Peter Benjamin MacDonald
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2228-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The internal validity of arthroscopic simulators and their effectiveness in arthroscopic education

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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