Abstract
Objective
To investigate the effect of lab-based simulator training, on the ability of surgical trainees to perform diagnostic knee arthroscopy.
Method
20 orthopaedic SHOs with minimal arthroscopic experience were randomised to 2 groups. 10 received a fixed protocol of simulator based arthroscopic skills training using a bench-top knee model. Learning curves were clearly demonstrated using motion analysis equipment to monitor performance. All 20 then spent an operating list with a blinded consultant trainer. They received instruction and demonstration of diagnostic knee arthroscopy before performing the procedure independently. Their performance was assessed using the intra-operative section of the Orthopaedic Competence Assessment Project (OCAP) procedure based assessment (PBA) protocol for diagnostic arthroscopy. Performance was further quantified with a ten point global rating assessment scale.
Results
Motion analysis demonstrated objective and significant improvement in performance during simulator training. In theatre the simulator-trained group performed significantly better than the untrained group. The simulator trainees were scored as OCAP competent on more than 70% of occasions, compared to less than 15% for the untrained group (p<0.01). The mean global rating score of the trained group was 24.5 out of 45 compared with 12 for the untrained group (p<0.01).
Conclusion
Learning curves showing significantly improved performance at simulated diagnostic knee arthroscopy are clearly demonstrated using motion analysis assessment. Arthroscopic simulator training led to subsequent significant improvement in operating theatre performance as determined by OCAP and a global rating assessment scale. This demonstrates a degree of transfer validity from lab based arthroscopic simulator training using motion analysis assessment to the operating theatre. In addition OCAP PBAs appear to provide a useful framework for in theatre assessment; however questions are raised about the need for more objective assessment tools in order to truly distinguish between trainees varying levels of competence.
