Bhattacharyya Rahul, Davidson Donald J, Sugand Kapil, Bartlett Matthew J, Bhattacharya Rajarshi, Gupte Chinmay M
1Imperial College London, London, United Kingdom 2Northwest Thames Deanery, London, United Kingdom 3Northwick Park Hospital, London, United Kingdom 4Imperial College Hospitals NHS Trust, London, United Kingdom.
J Bone Joint Surg Am. 2017 Oct 4;99(19):e103. doi: 10.2106/JBJS.17.00190.
Virtual-reality and cadaveric simulations are expensive and not readily accessible. Innovative and accessible training adjuncts are required to help to meet training needs. Cognitive task analysis has been used extensively to train pilots and in other surgical specialties. However, the use of cognitive task analyses within orthopaedics is in its infancy. The purpose of this study was to evaluate the effectiveness of a novel cognitive task analysis tool to train novice surgeons in diagnostic knee arthroscopy in high-fidelity, phantom-limb simulation.
Three expert knee surgeons were interviewed independently to generate a list of technical steps, decision points, and errors for diagnostic knee arthroscopy. A modified Delphi technique was used to generate the final cognitive task analysis. A video and a voiceover were recorded for each phase of this procedure. These were combined to produce the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool that utilizes written and audiovisual stimuli to describe each phase of a diagnostic knee arthroscopy. In this double-blinded, randomized controlled trial, a power calculation was performed prior to recruitment. Sixteen novice orthopaedic trainees who performed ≤10 diagnostic knee arthroscopies were randomized into 2 equal groups. The intervention group (IKACTA group) was given the IKACTA tool and the control group had no additional learning material. They were assessed objectively (validated Arthroscopic Surgical Skill Evaluation Tool [ASSET] global rating scale) on a high-fidelity, phantom-knee simulator. All participants, using the Likert rating scale, subjectively rated the tool.
The mean ASSET score (and standard deviation) was 19.5 ± 3.7 points in the IKACTA group and 10.6 ± 2.3 points in the control group, resulting in an improvement of 8.9 points (95% confidence interval, 7.6 to 10.1 points; p = 0.002); the score was determined as 51.3% (19.5 of 38) for the IKACTA group, 27.9% (10.6 of 38) for the control group, and 23.4% (8.9 of 38) for the improvement. All participants agreed that the cognitive task analysis learning tool was a useful training adjunct to learning in the operating room.
To our knowledge, this is the first cognitive task analysis in diagnostic knee arthroscopy that is user-friendly and inexpensive and has demonstrated significant benefits in training.
The IKACTA will provide trainees with a demonstrably strong foundation in diagnostic knee arthroscopy that will flatten learning curves in both technical skills and decision-making.
虚拟现实和尸体模拟成本高昂且不易获得。需要创新且易于获取的培训辅助工具来满足培训需求。认知任务分析已广泛应用于飞行员培训及其他外科专业。然而，在骨科领域，认知任务分析的应用尚处于起步阶段。本研究的目的是评估一种新型认知任务分析工具在高保真幻肢模拟中培训新手外科医生进行诊断性膝关节镜检查的有效性。
独立采访三位膝关节外科专家，以生成诊断性膝关节镜检查的技术步骤、决策点和错误列表。采用改良的德尔菲技术生成最终的认知任务分析。为该程序的每个阶段录制视频和旁白。将这些内容结合起来制作了帝国膝关节镜认知任务分析（IKACTA）工具，该工具利用书面和视听刺激来描述诊断性膝关节镜检查的每个阶段。在这项双盲随机对照试验中，招募前进行了样本量计算。16名进行≤10次诊断性膝关节镜检查的骨科新手学员被随机分为两组。干预组（IKACTA组）使用IKACTA工具，对照组没有额外的学习材料。他们在高保真幻肢模拟器上接受客观评估（经过验证的关节镜外科技能评估工具[ASSET]整体评分量表）。所有参与者使用李克特量表对该工具进行主观评分。
IKACTA组的平均ASSET评分（及标准差）为19.5±3.7分，对照组为10.
