Department of Surgery, Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, Maryland.
Department of Surgery, Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, Maryland.
J Surg Educ. 2022 Sep-Oct;79(5):1282-1294. doi: 10.1016/j.jsurg.2022.03.010. Epub 2022 May 15.
Simulation has become a widely accepted part of training and credentialing processes due to its ability to supplement technical skill acquisition outside of the operating room (OR). This project explores implementation of a bench-top simulation of open reduction with internal fixation (ORIF) as a cost-effective method for practicing and evaluating surgical skill.
DESIGN, SETTING, AND PARTICIPANTS: Participants ranging from intern to attending surgeon performed ORIF using a standard fixation set and a bovine or porcine tibia/radius model. Performance was recorded and scored by blinded reviewers based on a modified global rating scale (GRS), objective structured assessment of technical skills (OSATS) procedure-specific checklist, and critical-mistakes (CM) model. We calculated Fleiss' kappa for inter-rater reliability, Cronbach's alpha for internal consistency of scoring systems, and used univariate analysis to determine the ability of this model to discriminate between training levels. We also performed a normalized performance-versus-cost analysis to characterize perceived value of this simulation compared to other modalities.
Twenty subjects completed the fracture fixation exercise. Fleiss' kappa for all scoring systems indicated substantial inter-rater agreement (k = 0.81, 0.80, and 0.74 for GRS, OSATS, and CM, respectively). Internal consistency reliability for GRS and OSATS were high with Cronbach's alpha 0.96(95%CI 0.94-0.97) and 0.94(95%CI 0.91-0.96), respectively. Using a Kuskal-Wallis rank sum test, GRS, OSATS, and CM were found effective for measuring differences between resident levels (p < 0.001, p < 0.001, and p = 0.002, respectively). Qualitative valuation of the exercise indicated similar value for education compared to time spent in the OR and surgical skills labs.
This benchtop surgical simulation provides quantitative measurement of operative skills progression, increases trainee familiarity with ORIF principles, and permits targeted education by senior surgeons with the goal of training safe graduates. Procedure-specific checklist grading tools reliably differentiated between training levels with high internal validity. Implementing this model may decrease training costs and accelerate skill acquisition.
由于模拟能够在手术室（OR）之外补充技术技能的获取，因此它已成为培训和认证过程中广泛接受的一部分。本项目探讨了将开放式复位内固定（ORIF）的台式模拟作为一种具有成本效益的练习和评估手术技能的方法。
设计、环境和参与者：从住院医师到主治医生的参与者使用标准固定套件和牛或猪胫骨/桡骨模型进行 ORIF。表现由盲审员根据改良的总体评分量表（GRS）、客观结构化评估技术技能（OSATS）特定程序检查表和关键错误（CM）模型进行记录和评分。我们计算了 Fleiss' kappa 以评估评分系统的组间可靠性，Cronbach's alpha 以评估评分系统的内部一致性，并使用单变量分析来确定该模型区分培训水平的能力。我们还进行了归一化绩效与成本分析，以确定与其他模式相比，这种模拟的感知价值。
20 名受试者完成了骨折固定练习。所有评分系统的 Fleiss' kappa 均表明组间存在显著一致性（GRS、OSATS 和 CM 的 k 值分别为 0.81、0.80 和 0.74）。GRS 和 OSATS 的内部一致性信度较高，Cronbach's alpha 分别为 0.96（95%CI 0.94-0.97）和 0.94（95%CI 0.91-0.96）。使用 Kruskal-Wallis 秩和检验发现，GRS、OSATS 和 CM 均有效用于衡量住院医师水平之间的差异（p<0.001、p<0.001 和 p=0.002，分别）。对练习的定性评估表明，与在 OR 和手术技能实验室花费的时间相比，它对教育具有相似的价值。
这种台式手术模拟提供了手术技能进展的定量测量，增加了受训者对 ORIF 原则的熟悉程度，并允许高级外科医生进行有针对性的教育，目标是培养安全的毕业生。具有高内部有效性的特定程序检查表评分工具可靠地区分了培训水平。实施该模型可以降低培训成本并加速技能获取。
