Identifying Technical Procedures in Orthopaedic Surgery and Traumatology That Should Be Integrated in a Simulation-Based Curriculum

Abstract

Background: Simulation-based training is emerging within the orthopaedic field to alleviate the challenges that trainees face such as work-hour restrictions, limited exposure to procedures, and increasing pressures to reduce risk to patients. This training modality has grown increasingly popular over the last 2 decades. However, integration into the curriculum often fails to follow a structured educational plan. The development of simulation-based curricula should follow a structured and stepwise approach that starts with a general needs assessment. This study aimed to identify and prioritize procedures within orthopaedic surgery to be included in a simulation-based curriculum on a national basis. Methods: A national needs assessment was conducted using the Delphi method. Ninety-five experts who are involved in the training of orthopaedic surgeons from all orthopaedic departments in Denmark were selected to participate in the assessment. Round 1 was a brainstorming phase to identify technical procedures that are relevant for orthopaedic surgeons in training. Round 2 was performed on a departmental basis; it explored the frequency of procedures, the number of surgeons performing each procedure, the risk and/or discomfort to patients, and the feasibility for simulation-based training to prioritize and eliminate some of the procedures that were determined in round 1. During round 3, the experts eliminated and reprioritized procedures from round 2 to produce a final prioritized list. Results: During the first round, 194 procedures were identified. These were reduced to 62 in round 2, and the final list after round 3 consisted of 33 prioritized procedures that are relevant for simulation-based training in orthopaedic surgery. The response rates were 63 of 95 physicians for round 1, 26 of 26 departments for round 2, and 64 of 97 physicians for round 3. The highest prioritized procedures were basic surgical techniques and principles for osteosynthesis, osteosynthesis of proximal femoral fracture, and surgical exposure of the upper and lower extremities. Conclusions: The prioritized list of technical procedures in orthopaedic surgery that are suitable for simulation-based training can aid in the development of a simulation-based curriculum. Clinical Relevance: This article offers insights into needs assessment and curriculum development of simulation-based training in orthopaedic surgery and traumatology.

Contemporary Issues in the Acquisition of Orthopaedic Surgical Skills During Residency

“…Milestones 1.0 identified 16 surgical skills milestones for resident assessment in orthopaedics 14,22 . Another project in Denmark, by Gustafsson et al, through a remote Delphi needs assessment process, identified technical procedures in orthopaedic surgery that should be integrated in a simulation-based curriculum 23 . The findings of Gustafsson et al have a high degree of correlation with a third project, the competencies developed by the General Orthopaedic Competency Task Force, which are the general orthopaedic surgeon’s analogue to the residency milestones (Table I) 23,24 .…”

“…Another project in Denmark, by Gustafsson et al, through a remote Delphi needs assessment process, identified technical procedures in orthopaedic surgery that should be integrated in a simulation-based curriculum 23 . The findings of Gustafsson et al have a high degree of correlation with a third project, the competencies developed by the General Orthopaedic Competency Task Force, which are the general orthopaedic surgeon’s analogue to the residency milestones (Table I) 23,24 . Finally, U.K. governing bodies analogous to the ACGME and ABOS have driven the selection of 12 index procedures in which trainees must demonstrate competence prior to receiving a Certificate of Completion of Training in Trauma and Orthopaedic Surgery (Table I) 15 .…”

Einsatz von vorfrakturierten Präparaten für die Weiterbildung in Orthopädie und Unfallchirurgie

“…Eine Befragung von 95 Experten in Dänemark hat 33 Prozeduren identifiziert, die als Simulationstraining für Jungassistenten*innen geeignet wären [15]. Neben chirurgischen Basisfertigkeiten und den Prinzipien der Osteosynthese wurden hier spezifischer die Versorgung proximaler Femurfrakturen und die Zugangswegepräparation der oberen und unteren Extremität priorisiert.…”

“…Innerhalb dieses Zeitrahmens haben die Teilnehmer die Möglichkeit, die auf dem Markt vorhandenen Medizinprodukte und Innovationen kennenzulernen und sich hierbei einen umfangreichen Überblick zu schaffen (▶ Abb. Eine Befragung von 95 Experten in Dänemark hat 33 Prozeduren identifiziert, die als Simulationstraining für Jungassistenten*innen geeignet wären [15]. Neben chirurgischen Basisfertigkeiten und den Prinzipien der Osteosynthese wurden hier spezifischer die Versorgung proximaler Femurfrakturen und die Zugangswegepräparation der oberen und unteren Extremität priorisiert.…”

CORR Insights®: Surgical Skill Can be Objectively Measured From Fluoroscopic Images Using a Novel Image-based Decision Error Analysis (IDEA) Score

“…The use of simulation tools is vitally important to the future of surgical training [2,4]. Recent studies suggest that simulation can be effective in teaching several procedural skills and may show promise in assessing competence [1,6,13]. In orthopaedic surgery, simulators are most commonly used to teach procedural skills.…”