Advancing Simulation-Based Orthopaedic Surgical Skills Training: An Analysis of the Challenges to Implementation

Ateşok, Kıvanç; Hurwitz, Shepard R.; Anderson, Donald D.; Satava, Richard M.; Thomas, Geb; Tufescu, Ted; Heffernan, Michael J.; Papavassiliou, Efstathios; Theiss, Steven M.; Marsh, J. Lawrence

doi:10.1155/2019/2586034

Cited by 17 publications

(14 citation statements)

References 31 publications

(31 reference statements)

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“…Thus, HipSim-certified pretrained novices are prepared to continue the learning process under close supervision in the operating theatre. The orthopedic community is becoming increasingly aware and appreciates this beneficial aspect of simulation training (Morgan et al 2017 , Kalun et al 2018 , Atesok et al 2019 , Gustafsson et al 2019 ).…”

Section: Discussionmentioning

confidence: 99%

HipSim — hip fracture surgery simulation utilizing the Learning Curve–Cumulative Summation test (LC-CUSUM)

2020

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Background and purpose — Virtual reality simulation of hip fracture surgery is available for orthopedic residents nationwide in Denmark. Summative assessment of learning applying the learning curve cumulative summation test (LC-CUSUM) has not been utilized in orthopedic simulation training. The strength of the LC-CUSUM is that it assumes incompetency and signals competency based on solid statistics. We investigated the LC-CUSUM characteristics of novices stepwise mastering the simulated dynamic hip screw (DHS) procedure. Material and methods — 32 1st-year orthopedic residents participated in HipSim and its 3 subsequent LC-CUSUM evaluations: placing a Kirschner wire, placing a Kirschner wire in different patients, and performing the entire DHS procedure in different patients. The career status of the participants, i.e., still working in orthopedics or in another specialty was recorded ≥ 2 years after participation and associated with the simulation performance (passed/failed). Results — 13/14 participants passing HipSim according to LC-CUSUM were still working in orthopedics, while 9/18 participants failing HipSim had quit orthopedics at ≥ 2 years follow-up. The simulator-generated feedback did not statistically significantly differ between the groups. Interpretation — LC-CUSUM and its summative pass/fail assessment of each simulation was feasible in this formative simulation program. Clinical educators can be reassured that participants passing HipSim are likely to continue to 2nd–5th year of residency, while failing HipSim should raise concerns and trigger career counselling and clinical supervision. The motivational aspect of LC-CUSUM pass/fail assessment when designing formative simulation training warrants further research.

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Section: Discussionmentioning

confidence: 99%

HipSim — hip fracture surgery simulation utilizing the Learning Curve–Cumulative Summation test (LC-CUSUM)

2020

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“…A video can increase the realism of the situation during the simulation with ultrasound loops and laparoscopy footage. Simulation records can be reviewed either for debriefing or rating purposes [34,71,100,101]. A video is very useful for the training raters (e.g., for calibration and recalibration) [102].…”

Section: Debriefing Video and Research For Simulation-based Summative...mentioning

confidence: 99%

Simulation-based summative assessment in healthcare: an overview of key principles for practice

et al. 2022

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Background Healthcare curricula need summative assessments relevant to and representative of clinical situations to best select and train learners. Simulation provides multiple benefits with a growing literature base proving its utility for training in a formative context. Advancing to the next step, “the use of simulation for summative assessment” requires rigorous and evidence-based development because any summative assessment is high stakes for participants, trainers, and programs. The first step of this process is to identify the baseline from which we can start. Methods First, using a modified nominal group technique, a task force of 34 panelists defined topics to clarify the why, how, what, when, and who for using simulation-based summative assessment (SBSA). Second, each topic was explored by a group of panelists based on state-of-the-art literature reviews technique with a snowball method to identify further references. Our goal was to identify current knowledge and potential recommendations for future directions. Results were cross-checked among groups and reviewed by an independent expert committee. Results Seven topics were selected by the task force: “What can be assessed in simulation?”, “Assessment tools for SBSA”, “Consequences of undergoing the SBSA process”, “Scenarios for SBSA”, “Debriefing, video, and research for SBSA”, “Trainers for SBSA”, and “Implementation of SBSA in healthcare”. Together, these seven explorations provide an overview of what is known and can be done with relative certainty, and what is unknown and probably needs further investigation. Based on this work, we highlighted the trustworthiness of different summative assessment-related conclusions, the remaining important problems and questions, and their consequences for participants and institutions of how SBSA is conducted. Conclusion Our results identified among the seven topics one area with robust evidence in the literature (“What can be assessed in simulation?”), three areas with evidence that require guidance by expert opinion (“Assessment tools for SBSA”, “Scenarios for SBSA”, “Implementation of SBSA in healthcare”), and three areas with weak or emerging evidence (“Consequences of undergoing the SBSA process”, “Debriefing for SBSA”, “Trainers for SBSA”). Using SBSA holds much promise, with increasing demand for this application. Due to the important stakes involved, it must be rigorously conducted and supervised. Guidelines for good practice should be formalized to help with conduct and implementation. We believe this baseline can direct future investigation and the development of guidelines.

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“…9 To combat this, programs have started to implement resources that would help surgeons hone their surgical skills despite less operating room (OR) time, with a strong focus on validated simulation models that develop techniques directly transferable to the OR. 2,11 This allows trainees to cultivate proficiency in a variety of surgical approaches that may not have otherwise been retained due to a lack of spaced repetition.…”

Section: Footforummentioning

confidence: 99%

Do We Have to Walk Before We Can Run? Surgical Management of Calcaneus Fractures

Kwon

Williams

2019

Foot Ankle Int.

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Advancing Simulation-Based Orthopaedic Surgical Skills Training: An Analysis of the Challenges to Implementation

Cited by 17 publications

References 31 publications

HipSim — hip fracture surgery simulation utilizing the Learning Curve–Cumulative Summation test (LC-CUSUM)

HipSim — hip fracture surgery simulation utilizing the Learning Curve–Cumulative Summation test (LC-CUSUM)

Simulation-based summative assessment in healthcare: an overview of key principles for practice

Do We Have to Walk Before We Can Run? Surgical Management of Calcaneus Fractures

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