Departments of Orthopaedic Surgery (E.P.W., R.P.C., and D.T.M.) and Biostatistics and Bioinformatics (C.L.G.), Duke University Medical Center, Durham, North Carolina.
Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Bone Joint Surg Am. 2019 Feb 20;101(4):e14. doi: 10.2106/JBJS.17.01426.
Elements of competency-based training are being incorporated into surgical training. The primary objective of this study was to determine how the orientation of the arthroscope and the instruments relative to the standing position of the surgeon affects basic arthroscopic performance. The secondary objective was to determine how arthroscopic level of training affects performance.
Participants from a single academic institution were recruited and divided by level of training into 2 groups: novice and advanced. The Fundamentals of Arthroscopic Surgery Training (FAST) Workstation (Sawbones) was used in this study. Performance on the ring transfer module was evaluated based on the total number of ring transfers that were completed and the errors that were made in timed sessions. All participants performed the task with the arthroscope facing away from (position A) and facing toward (position B) their standing position. Two trials were completed for each position, followed by a survey.
Fifty-seven subjects participated in this study. Overall, position A showed 2.7 times the amount of transfers compared with position B (p < 0.001). The advanced group had 1.6 times more transfers in position A than the novice group (p = 0.007), and there was no significant difference in transfers between training level in position B. The advanced group had 3.6 times more transfers in position A compared with position B (p < 0.001), while the novice group had 2.0 times more transfers in position A than in position B (p < 0.001).
Performing an arthroscopic simulator task with the arthroscope directed toward the operator was found to be more difficult. An understanding of how the orientation of the operator, the arthroscope, and the instruments can strongly influence performance may be important for the primary surgeon, trainees, or assistants who may be standing opposite the arthroscope, and to optimize training to overcome this discrepancy.
基于能力的培训要素被纳入到外科培训中。本研究的主要目的是确定关节镜的方向和器械相对于术者的站立位置如何影响基本关节镜操作。次要目的是确定关节镜的训练水平如何影响操作。
本研究招募了来自单一学术机构的参与者，并根据培训水平将其分为 2 组：新手组和高级组。本研究使用基础关节镜手术培训（FAST）工作站（Sawbones）。基于在定时测试中完成的环转移总数和出现的错误来评估环转移模块的表现。所有参与者均以关节镜背对（位置 A）和面对（位置 B）他们的站立位置完成任务。每个位置完成 2 次测试，然后进行调查。
57 名受试者参加了这项研究。总的来说，位置 A 的转移次数是位置 B 的 2.7 倍（p < 0.001）。高级组在位置 A 的转移次数比新手组多 1.6 倍（p = 0.007），而在位置 B 时，两组之间的转移次数没有显著差异。高级组在位置 A 的转移次数是位置 B 的 3.6 倍（p < 0.001），而新手组在位置 A 的转移次数是位置 B 的 2.0 倍（p < 0.001）。
发现将关节镜指向操作者进行关节镜模拟任务更具挑战性。了解术者、关节镜和器械的方向如何强烈影响操作，对于可能站在关节镜对面的主刀医生、学员或助手可能很重要，并且优化培训以克服这种差异也很重要。
