Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.D. Karam:
Department of Mechanical and Industrial Engineering, The University of Iowa, 3131 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA 52242. E-mail address:
J Bone Joint Surg Am. 2015 Jun 17;97(12):1031-9. doi: 10.2106/JBJS.N.00748.
The evolving surgical skills education paradigm in orthopaedics has generated a strong demand for validated educational tools and methodologies. This study aimed to confirm that a one-on-one faculty coaching review of the head-mounted video recording of a resident's surgical performance on a validated articular fracture simulation trainer would substantially improve subsequent performance.
Fifteen first-year or second-year orthopaedic surgery residents reduced and fixed a standardized intra-articular tibial plafond fracture model under fluoroscopic guidance. Their performances were recorded by a head-mounted video camera. Prior to repeating the procedure six weeks later, eight subjects (the intervention group) reviewed the video of their performance with an orthopaedic traumatologist, and seven subjects (the control group) did not. Cohort performance was compared with respect to task duration, number of fluoroscopic images, and scores on the Objective Structured Assessment of Technical Skills (OSATS) as evaluated by fellowship-trained orthopaedic traumatologists blinded to the residents' year in training and prior surgical experience.
The initial performance OSATS scores were not significantly different (p ≥ 0.05) between the control and intervention groups. Assessments of their repeat performance showed a significant net interval improvement (p < 0.05) in OSATS scores in the intervention group (mean [and standard deviation], 21 ± 8 points) compared with the control group (6 ± 3 points). The mean fluoroscopy utilization had a significant net decrease (p < 0.05) in the intervention group (-5.4 ± 11.7 points) compared with the control group (5.3 ± 7.0 points). Task duration in the repeat performance was similar between both groups.
Personalized video-based feedback improved performance on a standardized articular fracture trainer for first-year and second-year residents. The described technique may further enhance resident surgical skills education.
骨科领域不断发展的手术技能教育模式产生了对经过验证的教育工具和方法的强烈需求。本研究旨在证实，对住院医师关节骨折模拟训练器上手术表现的头戴式视频记录进行一对一的教员辅导审查，将显著提高后续表现。
15 名一年级或二年级骨科住院医师在透视引导下减少并固定标准化关节内胫骨平台骨折模型。他们的表现由头戴式摄像机记录。在六周后重复该程序之前，8 名受试者（干预组）与骨科创伤专家一起查看他们的表现视频，而 7 名受试者（对照组）则没有。队列表现通过 fellowship 培训的骨科创伤专家进行比较，这些专家对住院医师的培训年份和先前的手术经验不了解，评估标准为任务持续时间、透视图像数量以及客观结构化评估技术技能（OSATS）评分。
对照组和干预组的初始 OSATS 评分无显著差异（p≥0.05）。对重复表现的评估显示，干预组的 OSATS 评分有显著的净间隔改善（p<0.05）（平均值[和标准差]，21±8 分），而对照组（6±3 分）。干预组的平均透视利用率有显著的净减少（p<0.05）（-5.4±11.7 分），而对照组（5.3±7.0 分）。两组重复表现的任务持续时间相似。
基于个性化视频的反馈提高了一年级和二年级住院医师在标准化关节骨折训练器上的表现。所描述的技术可能进一步增强住院医师的手术技能教育。
