Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
OrthoCarolina Hand Center, Charlotte, North Carolina.
J Surg Educ. 2018 Nov;75(6):1664-1672. doi: 10.1016/j.jsurg.2018.04.009. Epub 2018 May 3.
Wrist arthroscopy is a challenging discipline with limited training exposure during residency. The purpose of this study was to evaluate the effectiveness of virtual knee arthroscopy simulation training for gaining proficiency in wrist arthroscopy.
Participants were recorded performing a cadaveric wrist arthroscopy simulation. The residents then practiced knee arthroscopy on a virtual reality simulator and repeated the wrist arthroscopy simulation. All videos were blinded prior to assessment. Proficiency was graded using the Arthroscopic Surgery Skill Evaluation Tool global rating scale. In addition, participants were asked to complete a survey assessing the value of the virtual reality knee arthroscopy simulator for wrist arthroscopy.
Orthopaedic Surgery Residency Program, Carolinas Medical Center, a large, public, nonprofit hospital located in Charlotte, North Carolina.
Orthopaedic residents at our center were asked to participate in the simulation training. Participation was voluntary and nonincentivized. All orthopaedic residents at our institution (N = 27) agreed to participate. In total, there were 10 Intern (PGY-0 and PGY-1), 10 Junior (PGY-2 and PGY-3), and 7 Senior (PGY-4 and PGY-5) residents. In addition, a fellowship-trained hand surgeon was recruited to participate in the study, performing the wrist arthoscopy simulation. Two additional fellowship-trained hand surgeons, for a total of 3, assessed the blinded videos.
There was a trend toward better wrist Arthroscopic Surgery Skill Evaluation Tool scores by training level, although the difference was not statistically significant. Interns improved by an average of 1.8 points between baseline and postknee simulation tests. Junior and senior residents decreased by 1.6 and 5.0 points, respectively.
Knee arthroscopy simulation training did not objectively improve wrist arthroscopy proficiency among residents. A wrist-specific arthroscopy simulation program is needed if measurable competence through simulation is desired.
腕关节镜检查是一项具有挑战性的学科，住院医师培训期间的实践机会有限。本研究旨在评估虚拟膝关节镜检查模拟训练在腕关节镜检查中获得熟练程度的效果。
参与者在尸体腕关节镜检查模拟中进行记录。然后，住院医师在虚拟现实模拟器上练习膝关节镜检查，并重复腕关节镜检查模拟。在评估之前，所有视频均被屏蔽。熟练程度使用关节镜手术技能评估工具的总体评分进行分级。此外，参与者被要求完成一项评估虚拟现实膝关节镜检查模拟器对腕关节镜检查价值的调查。
卡罗来纳医疗中心骨科住院医师计划，这是一家位于北卡罗来纳州夏洛特市的大型公立非营利性医院。
我们中心的骨科住院医师被要求参加模拟培训。参与是自愿的，没有奖励。我们机构的所有骨科住院医师（N=27）都同意参加。共有 10 名住院医师（PGY-0 和 PGY-1）、10 名初级住院医师（PGY-2 和 PGY-3）和 7 名高级住院医师（PGY-4 和 PGY-5）。此外，还招募了一名手部关节镜外科医生来参与这项研究，进行腕关节镜检查模拟。另外还有 2 名手部关节镜外科医生，总共 3 名，对盲法视频进行了评估。
虽然差异无统计学意义，但随着培训水平的提高，腕关节 Arthroscopic Surgery Skill Evaluation Tool 评分呈上升趋势。住院医师在基线和膝关节模拟测试后分别提高了 1.8 分。初级和高级住院医师分别下降了 1.6 分和 5.0 分。
膝关节镜检查模拟训练并没有客观地提高住院医师的腕关节镜检查熟练程度。如果希望通过模拟获得可衡量的能力，则需要一个专门的腕关节镜检查模拟程序。
