Objectively assessing intraoperative arthroscopic skills performance and the transfer of simulation training in knee arthroscopy: a randomised controlled trial

Journal article

Purpose: Objectively investigate the transfer validity of simulation training, using wireless elbow-worn motion sensors intra-operatively to assess whether surgical simulation leads to improvements in intra-operative arthroscopic performance. Methods: Randomised controlled trial. PGY2-3 trainees in nationally-approved orthopaedic surgery posts were randomised to standard junior residency training (control group), or standard training plus additional weekly simulation training (intervention group). Both groups performed a supervised real-life diagnostic knee arthroscopy in the operating room at 13 weeks. Performance was measured using wireless elbow-worn motion sensors recording objective surgical performance metrics: the number of hand movements; smoothness; and time taken. A participant:supervisor performance ratio was used to adjust for variation in case-mix and difficulty. The study took place in a surgical simulation suite and orthopaedic operating rooms of a university teaching hospital. Results: The intervention group objectively outperformed the control group for all outcome metrics. Procedures performed by the intervention group required fewer hand movements (counts; 544[465-593] vs 893[747-1242], p<0.001), had smoother movements (ms-3; 25,842[20,867-27,468] vs 36,846[29,840-53,949], p<0.001) and took less time (seconds; 320[294-392] vs 573[477-860], p<0.001) than the control group. The cases were comparable between the groups. Standardised to the supervisors performance, the intervention group required fewer hand movements (1.9[1.5-2.1] vs 3.3[2.2-4.8], p=0.0091), less time (1.2[1.1-1.7] vs 2.6[1.6-3.0], p=0.0037) and were smoother (2.1[1.8-2.8] vs 4.3[2.8-5.4], p=0.0037) than the control group, but they didn’t perform as well as their supervisors.

Authors: Roberts, P; Alvand, A; Gallieri, M; Hargrove, C; Rees, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Arthroscopy: The Journal of Arthroscopy and Related Surgery
• Volume: 35
• Issue: 4
• Pages: 1197-1209.e1
• Publication date: 2019-03-14
• Acceptance date: 2018-11-12
• DOI: 10.1016/j.arthro.2018.11.035
• ISSN: 1526-3231
• Language: English
• Keywords: arthroscopy; motion analysis; simulation; surgical training; transfer validity