The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement

Abstract

Study Design:Prospective randomized study.Objectives:To define the impact of an inexpensive, user-friendly, and reproducible lumbar pedicle screw instrumentation bioskills training module and evaluation protocol.Methods:Participants were randomized to control (n = 9) or intervention (n = 10) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 20-minute bioskills training module while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of pedicle breach and breach anatomic location was measured pre- and posttest in lumbar spine models.Results:The intervention group showed a 30.8% improvement in PPDIS scores, compared with 13.4% for the control group (P = .01). The intervention group demonstrated statistically significant 66% decrease in breaches (P = .001) compared with 28% decrease in the control group (P = .06). Breach identification demonstrated no change in accuracy of the control group (incorrect identification from 32.2% pre- to posttest 35%; P = .71), whereas the intervention group’s improvement was statistically significant (42% pre- to posttest 36.5%; P = .0047).Conclusions:We conclude that a concise lumbar pedicle screw instrumentation bioskills training session can be a useful educational tool to augment clinical education.

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

“…Multiple studies have demonstrated that learning reten-tion increases with simulation, while practice and repetition with spinal instrumentation placement improve accuracy and decrease pedicle breach by trainees. 14,15,19,[35][36][37] Repetition is also valuable beyond training environments, as experienced spine surgeons exhibit decreased rates of breach compared with lesser-experienced surgeons in nonnavigated pedicle screw placement in adolescent idiopathic scoliosis. 4 Computer-assisted navigation for pedicle screw placement improves accuracy of pedicle screw insertion and reduces the need for surgical revision.…”

“…45 Therefore, adding this component to the model may improve trainee experience-based judgment. 37,38…”

Emerging Technologies within Spine Surgery

“…This consists of task-oriented goals performed outside of the traditional operating room setting. Directed bioskills training improves trainee technical performance and decreases in-lab operating errors [137]. The most commonly used method of bioskills training is the utilization of human cadaveric models [138].…”

A Systematic Review of Simulation-Based Training in Neurosurgery, Part 1: Cranial Neurosurgery

“…Bioskills training modules involving sawbone models were used to train both lumbar pedicle screw placement 84 and lumbar laminectomy 85 by the same group and assessed in a randomised trial. Both studies described the use of the OSATS, and the PPDIS and thus a rating 2 for response processes was achieved.…”