Department of Surgery, Health Science Centre, Room Orthopaedic Surgery G207, University of Calgary, 3330 Hospital Drive N.W., Calgary, AB T2N 4N1, Canada.
J Bone Joint Surg Am. 2013 May 1;95(9):e60, S1-5. doi: 10.2106/JBJS.K.01284.
Surgical trainees develop surgical skills using various techniques, with simulators providing a safe learning environment. Fracture fixation is the most common procedure in orthopaedic surgery, and residents may benefit from simulated fracture fixation. The performance of residents on a virtual simulator that allows them to practice the surgical fixation of fractures by providing a sense of touch (haptics) has not yet been compared with their performance using other methods of practicing fracture fixation, such as a Sawbones simulator model. The purpose of this study was to assess whether residents performed similarly on a newly developed virtual simulator compared with a Sawbones simulator fracture fixation model.
A stratified, randomized controlled study involving twenty-two orthopaedic surgery residents was performed. The residents were randomized to first perform surgical fixation of the ulna on either the virtual or the Sawbones simulator, after which they performed the same procedure on the other simulator. Their performance was evaluated by examiners experienced in fracture fixation who completed a task-specific checklist, global rating scale (GRS) form, and time-to-completion record for each participant on each simulator.
Both simulators distinguished between differing experience levels, demonstrating construct validity; for the Sawbones simulator, the Cohen d value (effect size) was >0.90, and for the virtual simulator, d was >1.10 (p < 0.05 for both). The participants achieved significantly better scores on the virtual simulator compared with the Sawbones simulator (p < 0.05) for all measures except time to completion. The GRS scores showed a high level of internal consistency (Cronbach α, >0.80). However, Pearson product-moment correlation analysis showed no significant correlations between the results on the two simulators; therefore, concurrent validity was not achieved.
The newly developed virtual ulnar surgical fixation simulator, which incorporates haptics, shows promise for helping surgical trainees learn and practice basic skills, but it did not attain the same standards as the current standard Sawbones simulator. The procedural measures used to assess resident performance demonstrated good reliability and validity, and both the Sawbones and the virtual simulator showed evidence of construct validity.
外科培训生使用各种技术来发展手术技能，模拟器为安全的学习环境提供了保障。骨折固定是骨科手术中最常见的程序，住院医师可能会受益于模拟骨折固定。住院医师在一个允许他们通过触觉（触觉）练习手术固定骨折的虚拟模拟器上的表现，尚未与他们使用其他练习骨折固定的方法（如 Sawbones 模拟器模型）进行比较。本研究的目的是评估住院医师在新开发的虚拟模拟器上的表现是否与在 Sawbones 模拟器骨折固定模型上的表现相似。
进行了一项分层、随机对照研究，涉及 22 名骨科手术住院医师。住院医师被随机分配到首先在虚拟或 Sawbones 模拟器上进行尺骨的手术固定，然后在另一个模拟器上进行相同的程序。他们的表现由在骨折固定方面经验丰富的考官通过完成特定任务检查表、总体评分量表（GRS）表格和每个模拟器上每个参与者的完成时间记录来评估。
两个模拟器都区分了不同的经验水平，证明了结构有效性；对于 Sawbones 模拟器，Cohen d 值（效应大小）>0.90，对于虚拟模拟器，d 值>1.10（两者均 p <0.05）。与 Sawbones 模拟器相比，参与者在虚拟模拟器上获得了明显更好的分数（p <0.05），除了完成时间之外，所有指标都是如此。GRS 评分显示出高度的内部一致性（Cronbach α >0.80）。然而，皮尔逊积矩相关分析显示两个模拟器的结果之间没有显著相关性；因此，没有达到同时有效性。
新开发的虚拟尺骨外科固定模拟器，结合触觉，有望帮助外科培训生学习和练习基本技能，但它没有达到当前标准 Sawbones 模拟器的标准。用于评估住院医师表现的程序措施表现出良好的可靠性和有效性，Sawbones 和虚拟模拟器都显示出结构有效性的证据。
