Practicing Procedural Skills Is More Effective Than Basic Psychomotor Training in Knee Arthroscopy: A Randomized Study

Abstract

Background: Simulator-assisted arthroscopy education traditionally consists of initial training of basic psychomotor skills before advancing to more complex procedural tasks. Purpose: To explore and compare the effects of basic psychomotor skills training versus procedural skills training on novice surgeons’ subsequent simulated knee arthroscopy performance. Study Design: Controlled laboratory study. Methods: Overall, 22 novice orthopaedic surgeons and 11 experienced arthroscopic surgeons participated in this study, conducted from September 2015 to January 2017. Novices received a standardized introductory lesson on knee arthroscopy before being randomized into a basic skills training group or a procedural skills training group. Each group performed 2 sessions on a computer-assisted knee arthroscopy simulator: The basic skills training group completed 1 session consisting of basic psychomotor skills modules and 1 session of procedural modules (diagnostic knee arthroscopy and meniscal resection), whereas the procedural skills training group completed 2 sessions of procedural modules. Performance of the novices was compared with that of the experienced surgeons to explore evidence of validity for the basic psychomotor training skills modules and the procedural modules. The effect of prior basic psychomotor skills training and procedural skills training was explored by comparing pre- and posttraining performances of the randomized groups using a mixed-effects regression model. Results: Validity evidence was found for the procedural modules, as test results were reliable and experienced surgeons significantly outperformed novices. We found no evidence of validity for the basic psychomotor skills modules, as test scores were unreliable and there was no difference in performance between the experienced surgeons and novices. We found no statistical effect of basic psychomotor skills training as compared with no training ( P = .49). We found a statistically significant effect of prior procedural skills training ( P < .001) and a significantly larger effect of procedural skills training as compared with basic psychomotor skills training ( P = .019). Conclusion: Procedural skills training was significantly more effective than basic psychomotor skills training regarding improved performance in diagnostic knee arthroscopy and meniscal resection on a knee arthroscopy simulator. Furthermore, the basic psychomotor skills modules lacked validity evidence. Clinical Relevance: On the basis of these results, we suggest that future competency-based curricula focus their training on full knee arthroscopy procedures. This could improve future education programs.

Hand dominance and experience improve bimanual performance on arthroscopic simulator task

“…Performance demonstrated in expert and novice surgeons in simulated arthroscopic procedures has been evaluated to identify transfer validity of simulation-based modules into orthopaedic practice [ 10 ]. While waypoints to evaluate the acquisition of arthroscopic technical skills through simulation training are varied [ 10 ]; the use of virtual reality in conferring skills required for arthroscopic surgery has been demonstrated to be an effective training method to prepare trainees for future arthroscopic procedures [ 5 ].…”