Martin Kevin D, Patterson David, Phisitkul Phinit, Cameron Kenneth L, Femino John, Amendola Annunziato
Orthopaedic Surgery, University of Iowa Sports Medicine Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Orthopaedic Surgery, University of Iowa Sports Medicine Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Foot Ankle Int. 2015 Jul;36(7):827-35. doi: 10.1177/1071100715576369. Epub 2015 Mar 11.
The purpose of this study was to determine whether low-fidelity arthroscopic simulation training improves basic ankle arthroscopy performance and efficiency among orthopedic trainees.
Twenty-nine orthopedic surgery trainees with varying levels of experience in ankle arthroscopy were randomized into either simulation or standard practice groups. At baseline testing, all participants performed simulator-based testing and a cadaveric diagnostic ankle arthroscopy with video recording. The simulation group subsequently received 4 one-on-one, 15-minute simulation training sessions over a 4-month period, while the standard practice group received no additional simulation training or exposure. After intervention, both groups were reevaluated with simulator testing and a second recorded cadaveric diagnostic ankle arthroscopy. Two blinded, independent experts evaluated each randomized arthroscopic performance using the 15-point checklist, Arthroscopic Surgery Skill Evaluation Tool (ASSET), and total elapsed time, and all outcome measures were compared within and between groups.
Baseline arthroscopic experience, simulator task performance measures, and ASSET scores were equivalent between the simulation and standard practice groups. After completion of training, the simulation group outscored the control group in total ASSET score (34.9 vs 19.6; P < .001) and checklist score (14.5 vs 8.4; P < .001) and achieved nearly expert ASSET Safety scores (4.7 vs 2.9; P < .001) on the simulator model. Cadaver testing also demonstrated significant improvements in total ASSET score (28.8 vs 16.8; P < .001), checklist score (12.6 vs 7.1; P < .001), and ASSET Safety score (3.9 vs 2.6; P < .001).
These results demonstrate that low-fidelity ankle arthroscopy simulation training can improve basic surgical skills, efficiency of movement, and anatomic recognition. The results suggest greater patient safety during ankle arthroscopy following simulation training.
Level I, prospective comparative study.
本研究旨在确定低逼真度关节镜模拟训练是否能提高骨科住院医师的基本踝关节镜手术操作水平和效率。
29名踝关节镜手术经验各异的骨科住院医师被随机分为模拟训练组或标准练习组。在基线测试时，所有参与者都进行了基于模拟器的测试以及尸体诊断性踝关节镜检查并录像。模拟训练组随后在4个月内接受了4次一对一、每次15分钟的模拟训练课程，而标准练习组未接受额外的模拟训练或接触。干预后，两组均通过模拟器测试和第二次录像的尸体诊断性踝关节镜检查进行重新评估。两名 blinded、独立的专家使用15分的检查表、关节镜外科技能评估工具（ASSET）和总耗时对每次随机的关节镜操作表现进行评估，并且在组内和组间比较所有结果指标。
模拟训练组和标准练习组在基线关节镜经验、模拟器任务表现指标和ASSET评分方面相当。训练完成后，模拟训练组在ASSET总分（34.9对19.6；P < .001）和检查表评分（14.5对8.4；P < .001）上超过对照组，并且在模拟器模型上获得了近乎专家级的ASSET安全评分（4.7对2.9；P < .001）。尸体测试也显示在ASSET总分（28.8对16.8；P < .001）、检查表评分（12.6对7.1；P < .001）和ASSET安全评分（3.9对2.6；P < .001）方面有显著改善。
这些结果表明低逼真度踝关节镜模拟训练可以提高基本手术技能、动作效率和解剖识别能力。结果提示模拟训练后踝关节镜检查期间患者安全性更高。
I级，前瞻性比较研究。
