Sleep Deprivation Adversely Impacts Resident Performance for Simulated Arthroscopy

Abstract

Purpose The purpose of the study was to assess the performance of residents in orthopaedics before and after a 24-hour shift on a shoulder arthroscopy simulator. The primary study endpoint was an overall performance score (OPS) generated by the simulator. Methods A prospective, comparative study of 120 simulator trials by 10 resident junior surgeons was performed in our university hospital’s simulation center between May and November 2018. To avoid memorization bias, all participants performed the same exercise 10 times on a VirtaMed ArthroS simulator prior to the study. Each resident’s performance (the OPS, the operating time, the proportion of procedures with iatrogenic lesions, the camera path length and the hook path length) in two different simulated arthroscopy exercise tasks was assessed once before and once after a 24-hour shift. This sequence was performed three times during the semester, and the change over time in performance was also evaluated. Results The OPS was significantly lower after the night shift ( P = 0.035 for the first exercise, and P = 0.025 for the second). Conclusion In a group of previously trained resident junior surgeons, overall performance with an arthroscopy simulator was significantly worse after a 24-hour shift. The study of secondary parameters of the OPS and the subgroup analysis based on the sleep time and Epworth score vary depending on the type of exercise performed arthroscopically. However, the use of a simulator after a night shift did not prevent the trainee from improving his/her level of performance over time. Level of Evidence II, a prospective, comparative study

Evaluating effectiveness of cadaveric arthroscopic training for orthopaedic residents: A comparison of joints and training levels

“…While many studies have found positive correlations between seniority and surgical outcomes [ 30 ], only a few evaluated the impact of seniority on learning outcomes [ 3 , 5 , 22 ]. For example, Baumann et al found that the level of seniority was strongly correlated with performance on diagnostic ankle arthroscopy in a cadaveric model and observed year‐to‐year increases in global operative skills rating scales, task‐specific checklists, and oral questionnaires [ 3 ]. Martin et al also reported similar findings in shoulder arthroscopic training, noting a 16‐s improvement in the time required to complete a standardised object localisation task for every additional year of seniority [ 22 ].…”

“…In shoulder, knee and ankle arthroscopy, a positive correlation was found between training level (postgraduate year [PGY]) and performance [ 15 , 22 ]. Sleep deprivation, in contrast, negatively affects the outcome of simulator training for residents [ 3 ]. Interestingly, Henn et al found that simulation training in knee arthroscopy did not improve proficiency in wrist arthroscopy among residents, indicating that competence in arthroscopy was not transferrable between joints, and a joint‐specific arthroscopy training programme is needed [ 13 ].…”