Ferguson Jamie, Middleton Robert, Alvand Abtin, Rees Jonathan
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Lane, Headington, Oxford, OX3 7LD, UK.
Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):608-615. doi: 10.1007/s00167-015-3766-6. Epub 2015 Aug 30.
This randomized study investigates whether novices learning simulation-based arthroscopic skills in one anatomical joint environment can immediately transfer their learnt skills to another joint.
Medical students were randomized to a simulated diagnostic knee or shoulder arthroscopic task on benchtop training models. After nine task repetitions over 3 weeks on one model, each participant undertook the simulation task of the other anatomical joint. Performance was objectively measured using a validated electromagnetic motion analysis system and a validated global rating scale (GRS).
Eighteen students participated; eight started the knee task and ten the shoulder task. All participants demonstrated a learning curve in all parameters during task repetition (time taken, hand path length, number of hand movements and GRS scores; p < 0.001) with learning effects >1 SD from initial performance (range 1.1-2.2 SD). When the groups swapped models, there was no immediate evidence of skill transfer, with a significant drop in performance between the final training episode and the transfer task (all parameters p < 0.003). In particular, the transfer task performance was no better than the first episode performance on that model by these novices.
This study showed basic arthroscopic skills did not immediately transfer to an unfamiliar anatomical environment within a simulated setting. These findings have important clinical implications with regard to surgical training as they potentially challenge the assumption that arthroscopic skills acquired in one joint are universally transferrable to other joints. Future orthopaedic simulation training should aim to deliver exposure to a greater variety of arthroscopic procedures and joint environments. This would allow trainees to become familiar with the different arthroscopic setting before undertaking real surgery and consequently improve patient safety.
Therapeutic, Level II.
本随机研究旨在调查在一个解剖关节环境中学习基于模拟的关节镜技能的新手是否能立即将所学技能转移到另一个关节。
医学生被随机分配到在台式训练模型上进行模拟诊断性膝关节或肩关节镜检查任务。在一个模型上经过3周9次任务重复后，每位参与者进行另一个解剖关节的模拟任务。使用经过验证的电磁运动分析系统和经过验证的整体评分量表（GRS）客观测量表现。
18名学生参与；8名开始膝关节任务，10名开始肩关节任务。所有参与者在任务重复期间所有参数（所用时间、手部路径长度、手部动作数量和GRS评分；p < 0.001）均呈现学习曲线，学习效果比初始表现高出>1个标准差（范围为1.1 - 2.2个标准差）。当两组交换模型时，没有立即出现技能转移的证据，最终训练阶段和转移任务之间的表现显著下降（所有参数p < 0.003）。特别是，这些新手在转移任务中的表现并不比在该模型上的首次训练表现更好。
本研究表明，在模拟环境中，基本关节镜技能不会立即转移到不熟悉的解剖环境。这些发现对手术训练具有重要的临床意义，因为它们可能挑战了在一个关节中获得的关节镜技能可普遍转移到其他关节的假设。未来的骨科模拟训练应旨在让学员接触更多种类的关节镜手术和关节环境。这将使学员在进行实际手术之前熟悉不同的关节镜环境，从而提高患者安全性。
治疗性，二级。
