Banaszek Daniel, You Daniel, Chang Justues, Pickell Michael, Hesse Daniel, Hopman Wilma M, Borschneck Daniel, Bardana Davide
1Department of Surgery, Queen's University School of Medicine, Kingston, Ontario, Canada 2Department of Surgery, Kingston General Hospital, Kingston, Ontario, Canada.
J Bone Joint Surg Am. 2017 Apr 5;99(7):e34. doi: 10.2106/JBJS.16.00324.
Work-hour restrictions as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and other governing bodies have forced training programs to seek out new learning tools to accelerate acquisition of both medical skills and knowledge. As a result, competency-based training has become an important part of residency training. The purpose of this study was to directly compare arthroscopic skill acquisition in both high-fidelity and low-fidelity simulator models and to assess skill transfer from either modality to a cadaveric specimen, simulating intraoperative conditions.
Forty surgical novices (pre-clerkship-level medical students) voluntarily participated in this trial. Baseline demographic data, as well as data on arthroscopic knowledge and skill, were collected prior to training. Subjects were randomized to 5-week independent training sessions on a high-fidelity virtual reality arthroscopic simulator or on a bench-top arthroscopic setup, or to an untrained control group. Post-training, subjects were asked to perform a diagnostic arthroscopy on both simulators and in a simulated intraoperative environment on a cadaveric knee. A more difficult surprise task was also incorporated to evaluate skill transfer. Subjects were evaluated using the Global Rating Scale (GRS), the 14-point arthroscopic checklist, and a timer to determine procedural efficiency (time per task). Secondary outcomes focused on objective measures of virtual reality simulator motion analysis.
Trainees on both simulators demonstrated a significant improvement (p < 0.05) in arthroscopic skills compared with baseline scores and untrained controls, both in and ex vivo. The virtual reality simulation group consistently outperformed the bench-top model group in the diagnostic arthroscopy crossover tests and in the simulated cadaveric setup. Furthermore, the virtual reality group demonstrated superior skill transfer in the surprise skill transfer task.
Both high-fidelity and low-fidelity simulation trainings were effective in arthroscopic skill acquisition. High-fidelity virtual reality simulation was superior to bench-top simulation in the acquisition of arthroscopic skills, both in the laboratory and in vivo. Further clinical investigation is needed to interpret the importance of these results.
研究生医学教育认证委员会（ACGME）及其他管理机构规定的工作时间限制，迫使培训项目寻找新的学习工具，以加速医学技能和知识的获取。因此，基于胜任力的培训已成为住院医师培训的重要组成部分。本研究的目的是直接比较高保真和低保真模拟器模型中关节镜技能的习得情况，并评估从任何一种模式到尸体标本的技能转移情况，模拟术中条件。
40名外科新手（临床实习前水平的医学生）自愿参加本试验。在培训前收集基线人口统计学数据以及关节镜知识和技能数据。受试者被随机分为三组，分别接受为期5周的高保真虚拟现实关节镜模拟器独立培训、台式关节镜设置独立培训或不接受培训的对照组。培训后，要求受试者在模拟器上以及在尸体膝关节的模拟术中环境中进行诊断性关节镜检查。还纳入了一项更具难度的突击任务以评估技能转移。使用全球评级量表（GRS）、14点关节镜检查清单和计时器对受试者进行评估，以确定操作效率（每项任务的时间）。次要结果侧重于虚拟现实模拟器运动分析的客观测量。
与基线分数和未接受培训的对照组相比，两种模拟器上的受训者在关节镜技能方面均有显著提高（p < 0.05），无论是在体外还是体内。在诊断性关节镜交叉测试和模拟尸体设置中，虚拟现实模拟组始终优于台式模型组。此外，虚拟现实组在突击技能转移任务中表现出卓越的技能转移能力。
高保真和低保真模拟培训在关节镜技能习得方面均有效。在实验室和体内，高保真虚拟现实模拟在关节镜技能习得方面优于台式模拟。需要进一步的临床研究来解读这些结果的重要性。
