Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen.
Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen; Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet.
Acta Orthop. 2024 Aug 28;95:477-484. doi: 10.2340/17453674.2024.41345.
Orthopedic trainees must be able to perform intraoperative fluoroscopy imaging to assess the surgical result after volar locking plate surgeries of distal radius fractures. Guided by Messick's contemporary validity framework, the aim of our study was to gather evidence of validity for a test of proficiency for intraoperative imaging of a distal radius fracture using a novel immersive virtual reality simulator.
11 novices and 9 experienced surgeons employed at orthopedic departments completed 2 individual simulator sessions. At each session the participants performed 3 repetitions of an intraoperative fluoroscopic control of a distal radius fracture, consisting of 5 different fluoroscopic views. Several performance metrics were automatically recorded by the simulator and compared between the 2 groups.
Simulator metrics for 3 of the 5 fluoroscopic views could discriminate between novices and experienced surgeons. An estimated composite score based on these 3 views showed good test-retest reliability, ICC = 0.82 (confidence interval 0.65-0.92; P < 0.001). A discriminatory standard was set at a composite score of 6.15 points resulting in 1 false positive (i.e., novice scoring better than the standard), and 1 false negative (i.e., experienced surgeon scoring worse than the standard).
This study provided validity evidence from all 5 sources of Messick's contemporary validity framework (content, response process, internal structure, relationship with other variables, and consequences) for a simulation-based test of proficiency in intraoperative fluoroscopic control of a distal radius fracture fixated by a volar locking plate.
矫形外科受训者必须能够进行术中透视成像，以评估掌侧锁定钢板治疗桡骨远端骨折手术后的手术结果。本研究以 Messick 的当代有效性框架为指导，旨在为使用新型沉浸式虚拟现实模拟器对桡骨远端骨折进行术中成像的熟练程度测试收集有效性证据。
11 名新手和 9 名在矫形外科工作的经验丰富的外科医生完成了 2 次单独的模拟器训练。在每次训练中，参与者重复进行 3 次桡骨远端骨折的术中透视控制，包括 5 种不同的透视视图。模拟器自动记录了几个性能指标，并在两组之间进行了比较。
5 种透视视图中的 3 种的模拟器指标可以区分新手和经验丰富的外科医生。基于这 3 种视图的估计综合评分显示出良好的测试-重测可靠性，ICC = 0.82（置信区间 0.65-0.92；P < 0.001）。将判别标准设定为综合评分为 6.15 分，导致 1 个假阳性（即新手的评分优于标准）和 1 个假阴性（即经验丰富的外科医生的评分低于标准）。
本研究从 Messick 的当代有效性框架的所有 5 个来源（内容、反应过程、内部结构、与其他变量的关系和后果）提供了基于模拟的桡骨远端骨折掌侧锁定钢板固定术中透视控制熟练程度测试的有效性证据。
