A Novel Approach for Assessing and Training the Drilling Skills of Orthopaedic Surgeons

Abstract

Background: Although experiences in the operating room can help surgeons to learn simple bone-drilling techniques, outside training may be better suited for complex procedures. We adapted a rotary handpiece to evaluate the bone-drilling skills of orthopaedic resident physicians during the 2017 Southwest Orthopaedic Trauma Association (SWOTA) motor skills course. Methods: Twenty-five postgraduate year (PGY)-1 orthopaedic residents from 7 institutions were asked to perform a bicortical drilling task 3 times both before and after attending a motor skills course. Kinetic and kinematic data were collected using force, acceleration, and visual sensors. Results: Sixteen parameters were measured. The interdependence of these parameters (taken separately for precourse and postcourse performance) is presented. Evidence for motor skill acquisition across a short time scale is elucidated. Noteworthy correlations include overpenetration with force (0.65 mm), palmar-dorsal (P-D) toggle (0.65°), vibration in the P-D direction (0.53 m/s2), time (−0.41 sec), and RPM (revolutions per minute; −0.36); time with both RPM (0.38) and P-D toggle (−0.40°); and force with both RPM (−0.41) and P-D toggle (0.32°). Differences in performance before and after the motor skills course include reduction in overpenetration (28.8 to 18.2 mm), reduction in skiving (22% to 6%), and reduction in preparation time (27.3 to 9.65 sec). Additionally, there were several differences in performance by institution that were significant (overpenetration, toggle in the P-D and radial-ulnar [R-U] directions, and both drilling force and drilling time). Conclusions: Understanding how performance and outcome parameters are correlated provides powerful insight into how surgical procedures can be best performed. In particular, we hope that these findings will inform new training paradigms. Variations in resident training from 1 institution to another are evidenced in surgical performance. Similarly, the methods used here to quantify changes in performance across the 3-day SWOTA training course allow a unique vehicle for optimization of these types of training opportunities outside of the operating room.

Drill Bone with Both Hands: Plunge Depth and Accuracy with 4 Bracing Positions

“…Limited information is available to guide orthopaedic educators on how to instruct orthopaedic trainees to hold and operate a bone drill to optimize their performance, either in the skills laboratory or in the operating room [13][14][15] . In addition, the impact of a single simulated bone drilling motor skills workshop on trainee acquisition of this skill is not well described.…”

“…Bone drilling accuracy and depth of plunge while drilling are associated with years of experience and both improve as trainees advance through residency 16,19,[21][22][23] . Equipment factors 1,[21][22][23][24] and surgical technique [13][14][15]17,20,21 also influence performance.…”

“…The Accreditation Council for Graduate Medical Education considers bone drilling a "critical step" of core orthopaedic procedures and a Level 3 competency milestone required for graduation from an orthopaedic surgery residency 12 . Contemporary orthopaedic surgical education prioritizes instruction in bone drilling in a laboratory workshop environment using synthetic bone models or cadaveric tissue before actual performance on living patients [13][14][15][16][17][18][19][20] . Bone drilling accuracy and depth of plunge while drilling are associated with years of experience and both improve as trainees advance through residency 16,19,[21][22][23] .…”

Masking Effects in Combined Hardness and Stiffness Rendering Using an Encountered-Type Haptic Display

“…For example, a correct perception of hardness is crucial in teleoperation in order for the operator to appropriately interact with the remote objects [8]. Medical haptic training simulators also require high-precision haptic force rendering to create an experience that closely matches clinical practice [11], [12].…”