Pedersen Poul, Palm Henrik, Ringsted Charlotte, Konge Lars
Department of Orthopaedic Surgery , Hospital of Nykøbing F.
Acta Orthop. 2014 Aug;85(4):403-7. doi: 10.3109/17453674.2014.917502. Epub 2014 Apr 30.
Internal fixation of hip fractures is a common and important procedure that orthopedic surgeons must master early in their career. Virtual-reality training could improve initial skills, and a simulation-based test would make it possible to ensure basic competency of junior surgeons before they proceed to supervised practice on patients. The aim of this study was to develop a reliable and valid test with credible pass/fail standards.
20 physicians (10 untrained novices and 10 experienced orthopedic surgeons) each performed 3 internal fixation procedures of an undisplaced femoral neck fracture: 2 hook-pins, 2 screws, and a sliding hip screw. All procedures were preformed on a trauma simulator. Performance scores for each procedure were obtained from the predefined metrics of the simulator. The inter-case reliability of the simulator metrics was explored by calculation of intra-class correlation coefficient. Validity was explored by comparison between novices' and experts' scores using independent-samples t-test. A pass/fail standard was set by the contrasting-groups method and the consequences were explored.
The percentage of maximum combined score (PM score) showed an inter-case reliability of 0.83 (95% CI: 0.65-0.93) between the 3 procedures. The mean PM score was 30% (CI: 7-53) for the novices and 76% (CI: 68-83) for the experienced surgeons. The pass/fail standard was set at 58%, resulting in none of the novices passing the test and a single experienced surgeon failing the test.
The simulation-based test was reliable and valid in our setting, and the pass/fail standard could discriminate between novices and experienced surgeons. Potentially, training and testing of future junior surgeons on a virtual-reality simulator could ensure basic competency before proceeding to supervised practice on patients.
髋部骨折内固定术是骨科医生在职业生涯早期必须掌握的常见且重要的手术。虚拟现实训练可提高初始技能，基于模拟的测试能够确保初级外科医生在对患者进行带教实践之前具备基本能力。本研究的目的是开发一种具有可靠通过/失败标准的可靠且有效的测试。
20名医生（10名未经训练的新手和10名经验丰富的骨科医生）每人对1例无移位股骨颈骨折进行3次内固定手术：2次使用钩钉、2次使用螺钉以及1次使用滑动髋螺钉。所有手术均在创伤模拟器上进行。每个手术的表现得分从模拟器的预定义指标中获取。通过计算组内相关系数来探索模拟器指标的病例间可靠性。通过使用独立样本t检验比较新手和专家的得分来探索有效性。通过对比组方法设定通过/失败标准并探究其结果。
3种手术之间的最大综合得分百分比（PM得分）显示病例间可靠性为0.83（95%CI：0.65 - 0.93）。新手的平均PM得分为30%（CI：7 - 53），经验丰富的外科医生为76%（CI：68 - 83）。通过/失败标准设定为58%，结果没有新手通过测试，只有1名经验丰富的外科医生未通过测试。
在我们的研究环境中，基于模拟的测试是可靠且有效的，通过/失败标准能够区分新手和经验丰富的外科医生。未来，在虚拟现实模拟器上对初级外科医生进行培训和测试可能会在对患者进行带教实践之前确保其基本能力。
