The internal validity of arthroscopic simulators and their effectiveness in arthroscopic education

Abstract

Excessive heterogeneity exists in the literature to determine the internal and transfer validity of arthroscopic simulators currently available. Evidence suggests that simulators can discriminate between novice and expert users, but discrimination between novice and intermediate trainees in surgical education should be paramount. International standards for the assessment of arthroscopic simulator validity should be developed to increase the use and effectiveness of simulators in orthopedic surgery.

Arthroscopic proficiency: methods in evaluating competency

“…These studies have high levels of internal validity and consistency, although most involve only basic arthroscopic skills, such as orientation and triangulation or only demonstrate improved performance in individuals with no previous arthroscopic experience [65]. Likewise, most validated simulators are only sensitive enough to discriminate between expert and novice skill levels [66]. The ability to detect smaller, yet clinically significant differences between intermediate skill levels is required to establish benchmarks and provide objective feedback to the training population of residents.…”

“…Two systematic reviews have failed to identify sufficient evidence of transfer validity within the arthroscopic literature [66,68]. This is also complicated by the heterogenicity of existing simulators being subjected to validity testing [66]. Further high-quality studies are required before the widespread acceptance of these tools into mainstream arthroscopic training programs.…”

Can Surgical Trainees Achieve Arthroscopic Competence at the End of Training Programs? A Cross-sectional Study Highlighting the Impact of Working Time Directives

“…Simulation based training seems likely to be a vital new adjunct in surgical training. Prior work has demonstrated improved learning and performance through simulation based training 21,22,[25][26][27] There is now a growing argument that simulation should be integrated into training programmes to improve learning, and to help reduce any skills gap. Within the UK, simulation is set to become part of the orthopaedic curriculum, although no realistic resources are yet in place to support such a move.. A similar recognition of the importance of simulation in training has been highlighted in the USA 28 , with collaboration between the American Academy of Orthopaedic Surgeons, the Arthroscopy Association of North America and the American Board of Orthopaedic Surgery to evaluate and improve the delivery of arthroscopic training using simulation.…”

Surgical skills simulation in trauma and orthopaedic training

“…Benefits of arthroscopic procedures are well known and include shorter recovery time, reduced risk of infection and option to perform in an outpatient setting. It has become a key component of practice and a core skill of orthopaedic training [ 11 , 12 , 15 , 26 ]. However, development of arthroscopic skills takes considerable time and is associated with a significant financial burden when this training takes place in the operating theatre [ 27 ].…”

“…Multiple studies have attempted to validate VR arthroscopic simulators by demonstrating a correlation between real-life arthroscopic experience and performance on a simulator [ 11 , 26 , 36 – 38 ]. Experienced surgeons have achieved better results in performing VR-simulated arthroscopic tasks as measured by one or a combination of time to complete a procedure, computer-assessed motion analysis compared with a predetermined optimum and number of probe collisions [ 29 , 30 , 39 – 41 ].…”