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

Abstract

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.

Standard Setting in Simulation-based Training of Surgical Procedures

“…Four studies used Cumulative Sum (CUSUM) analysis or learning curve plateau as the standard set goal for the training 80–83 . CUSUM analysis requires specific pass-fail criteria to group the learners, for example, acceptable failure rate.…”

“…CUSUM analysis requires specific pass-fail criteria to group the learners, for example, acceptable failure rate. Rölfing et al 82 for example explored standard setting using the CUSUM scores of novice learners in simulated dynamic hip screw placement.…”

“…Four studies used Cumulative Sum (CUSUM) analysis or learning curve plateau as the standard set goal for the training. [80][81][82][83] CUSUM analysis requires specific pass-fail criteria to group the learners, for example, acceptable failure rate. Ro ¨lfing et al 82 for example explored standard setting using the CUSUM scores of novice learners in simulated dynamic hip screw placement.…”

Learning Curve of USgHIFU Ablation for Uterine Fibroids: A Multi‐Center Prospective Study

“…13 It is an effective tool developed to assess whether the operator has a sufficient level of competence, and has been widely used in the evaluation of the ability of learners. [14][15][16] Therefore, in this study, LC-CUSUM was utilized to verify the technical stability of HIFU and explored the feasibility of physician training qualification under the standard of NPV ratio of 70%. What we have learned from this work is beneficial to the clinical promotion of HIFU ablation for the treatment of uterine fibroids.…”

Reducing orthopaedic theatre exposure during the COVID-19 lockdown: does a shift towards virtual reality-based training offer a solution?

“…Its benefit comes from the deliberate practice of key procedural steps, which the trainee can repeat in the virtual environment before transferring these skills to real patients (Ericsson and Harwell 2019 ). There is widely published evidence to suggest that repetitive practice is fundamental for orthopaedic surgical training, specifically for arthroscopic surgery and key steps in trauma procedures, e.g., femoral neck guidewire placement for dynamic hip screw fixation (Mabrey et al 2010 , Sadideen et al 2013 , Stirling et al 2014 , Thomas et al 2014 , Gustafsson et al 2019 , Rölfing et al 2020 ).…”