Aims. To develop a core outcome set of measurements from postoperative radiographs that can be used to assess
Aims. To identify a core outcome set of postoperative radiographic measurements to assess
Introduction. Restrictions placed on the working hours of doctors have led to increasing time-pressures on surgical training. Consequently, there has been growing interest in developing new techniques to teach and assess
Background. Revision total knee arthroplasty (rTKA) is a high stakes procedure with complex equipment and multiple steps. For rTKA using the ATTUNE system revising femoral and tibial components with sleeves and stems, there are over 240 pieces of equipment that require correct assembly at the appropriate time. Due to changing teams, work rotas, and the infrequency of rTKR, scrub nurses may encounter these operations infrequently and often rely heavily on company representatives to guide them. In turn, this delays and interrupts surgical efficiency and can result in error. This study investigates the impact of a fully immersive virtual reality (VR) curriculum on training scrub nurses in
Abstract. Introduction. Challenges in surgical training have led to the exploration of technologies such as augmented reality (AR), which present novel approaches to teaching orthopaedic procedures to medical students. The aim of this double-blinded randomised-controlled trial was to compare the validity and training effect of AR to traditional teaching on medical students’ understanding of total knee arthroplasty (TKA). Methodology. Twenty medical students from 7 UK universities were randomised equally to either intervention or control groups. The control received a consultant-led teaching session and the intervention received training via Microsoft HoloLens, where surgeons were able to project virtual information over physical objects. Participants completed written knowledge and practical exams which were assessed by 2 orthopaedic consultants. Training superiority was established via 4 quantitative outcome measures: OSATS scores, a checklist of TKA-specific steps, procedural time, and written exam scores. Qualitative feedback was evaluated using a 5-point Likert scale. Results. AR training was superior in teaching basic technical proficiency and understanding of TKA, with the intervention group significantly outperforming the control group in 3 metrics [OSATS (38.6%, p=0.021), checklist (33%, p=0.011) and written exam (54.5%, p=0.001)]. Procedural time was equivalent between cohorts (p=0.082). AR was rated as significantly more enjoyable (p=0.044), realistic (p=0.003), easy to understand (p=0.040), and proficient in teaching (p=0.02). Conclusion. In this adequately powered, double-blinded randomised-controlled trial, AR training demonstrated substantially improved translational
Simulation use in training is rapidly becoming a mainstay educational tool seen to offer perceived benefits of a safe environment for repeated practice and learning from errors without jeopardising patient safety. However, there is currently little evidence addressing the trainees’ perspectives and attitudes of simulation training, particularly in comparison with trainers and the educational community. This study investigates orthopaedic trainees’ and trainers’ conceptions of learning from simulation-based training, exploring whether the orthopaedic community are ‘on the same page’, with respect to each other and the educational community. Qualitative research in the form of semi-structured interviews is used to identify commonalities and differences between trainee and trainer conceptions, based on respective experiences and expectations, and suggests ways of enhancing collaboration between stakeholders to achieve better alignment of conceptions. The research revealed that orthopaedic trainees and trainers conceive key themes in a similar manner: supporting the role of simulation in developing the ‘pre-trained novice’ as opposed to skill refinement or maintenance; attributing greater importance to non-technical rather than
The aim of this study was to validate the use of three models of fracture fixation in the assessment of
Purpose: To evaluate fellowship trainee and supervisor perceptions on the relative importance of core cognitive and procedural competencies in spine subspecialty fellowship training. Method: A questionnaire was designed through synthesis and amalgamation of two previous surveys designed by other authors. This questionnaire was reviewed for content by spine surgery experts (Canadian Spine Society Education Committee). The questionnaire was administered (online and paper) to fellow trainees and supervisors across Canada and data was collected over a 3-month period. It consisted of 40 MCQ items grouped into 13 broad cognitive skills categories, as well as 29 technical/procedural items. Data was analyzed using qualitative and descriptive statistics (e.g. average mean scores, standard deviations, t-tests). Results: The response rate was 91%, with 15 of 17 fellow trainees and 47 of 51 supervisors completing the survey. Twelve of the 13 core cognitive skill categories were rated as being important to acquire by the end of fellowship. Trainees were not comfortable performing, and requested additional training in 8 of 29 spine surgery
Abstract. Objectives. Non-technical skills including teamwork play a pivotal role in surgical outcomes. Virtual reality is effective at improving
Background. Training within surgery is changing from the traditional Halstedian apprenticeship model. There is need for objective assessment of trainees, especially their
Introduction. Analysis of registry data shows that few units achieve results better than 99·98% control limits. Implant selection is considered a predictor of outcome variation in joint replacement. We analysed the outcomes of a unit with statistically “better than expected” results and compared to all other units within the National Joint Registry for England, Wales, Northern Ireland and Isle of Man (NJR). We sought to determine whether improved implant survival following primary total hip replacement (THR) is a centre effect or mediated by implant selection. Methods. We identified 664,761 THRs in the NJR. The exposure was the unit in which the THR was implanted and the outcome all-cause revision. Net failure was estimated using Kaplan-Meier and adjusted analyses used flexible parametric survival analysis. Results. The crude 10-year revision rate for THRs was 1·7% (95% CI: 1·3, 2·3) in the exemplar centre and 2·9% (95% CI: 2·8, 3·0) elsewhere (log rank test P<0·001). Of 6,230 THRs performed in the exemplar centre, 99·9% used the same femoral stem. After restricting analyses to this stem, crude survival from other units was 2·3% (95% CI: 2·2, 2·4) (log-rank test p=0·05). Age and sex adjusted analyses, restricted to the same stem/cup combinations as the exemplar centre, show no demonstrable difference in restricted mean survival time between groups (p=0·28). Conclusion. These results suggest the “better than expected” performance of an exemplar centre can be replicated by adopting key treatment decisions, such as implant selection. These decisions are easier to replicate than
Background. For total hip arthroplasty (THA), cognitive training prior to performing real surgery may be an effective adjunct alongside simulation to shorten the learning curve. This study sought to create a cognitive training tool to perform direct anterior approach THA, validated by expert surgeons; and test its use as a training tool compared to conventional material. Methods. We employed a modified Delphi method with four expert surgeons from three international centres of excellence. Surgeons were independently observed performing THA before undergoing semi-structured cognitive task analysis (CTA) before completing successive rounds of electronic surveys until consensus. The agreed CTA was incorporated into a mobile and web-based platform. Forty surgical trainees (CT1-ST4) were randomised to CTA-training or a digital op-tech with surgical videos, before performing a simulated DAA THA in a validated fully-immersive virtual reality simulator. Results. Experts reached 100% consensus after five rounds. They defined THA in 46 steps and 52 decision points in 8 distinct procedural phases. Each phase comprised of a set of actions, cognitive demands, and critical errors and strategies. This CTA was mapped onto an open-access web-based learning tool [1]. Surgeons who prepared with CTA performed a simulated THA more efficiently (Time: 26 vs. 36 minutes and Procedural steps: 64 vs. 78), with fewer errors in instrument selection (22 vs 34 instances) and help required (6 vs. 19 instances), and with more accuracy (acetabular cup inclination error: 7° vs. 12°, anteversion error: 11° vs 19°) than those who prepared with conventional material. Discussion. This is the first validated CTA tool for arthroplasty. It provides structure for competency-based learning of this complex procedure. It is more effective at preparing orthopaedic trainees for a new procedure than conventional materials, for learning sequence, instrumentation and motor skills. Implications. Cognitive training combines education on decision making, knowledge and
Total ankle replacement (TAR) is contraindicated in patients with significant talar collapse due to AVN and in these patients total talus body prosthesis has been proposed to restore ankle joint. To date, five studies have reported implantation of a custom-made talar body in patients with severely damaged talus, showing the limit of short-term damage of tibial and calcaneal thalamic joint surfaces. Four of this kind of implants have been performed. The first two realized with “traditional” technology CAD-CAM has been performed in active patients affected by “missing talus” and now presents a survival follow-up of 15 and 17 years. For the third patient affected by massive talus AVN we designed a 3D printed porous titanium custom talar body prosthesis fixed on the calcaneum and coupled with a TAR, first acquiring high-resolution 3D CT images of the contralateral healthy talus that was “mirroring” obtaining the volume of fractured talus in order to provide the optimal fit. Then the 3D printed implant was manufactured. The fourth concern a TAR septic mobilization with high bone loss of the talus. The “two-stage” reconstruction conducted with the implant of total tibio-talo-calcaneal prosthesis “custom made” built with the same technology 3D, entirely in titanium and using the “trabecular metal” technology for the calcaneous interface. Weightbearing has progressively allowed after 6 weeks. No complications were observed. All the implants are still in place with an overall joint mobility ranging from 40° to 60°. This treatment requires high demanding
With the rapid evolution of surgical techniques every practicing surgeon will need to introduce new skills into their practice. Despite evidence that introducing a new surgical technique is associated with a learning curve during which there are reduced surgical and patient outcomes, there are no suggested protocols in place to support a surgeon in safely introducing a procedure into established practice. The purpose of this pilot study was to compare the effects of a mentored approach to learning new
Aim. Segmental bone defects following osteomyelitis in pediatric age group may require specifically designed surgical options. Clinical and radiographic elements dictate the option. Different elements play a role on the surgeon's choice. Among them, the size of the defect, the size and the quality of the bone stock available, the status of the skin envelope, the involvement of the adjacent joint. When conditions occur, vascularized fibula flap may represent a solution in managing defects of the long bones even during the early years of life. Method. A retrospective study, covering the period between October 2013 and September 2015, was done. Fourteen patients, nine males, five females, aged 2–13 years, with mean skeletal defect of 8.6 cm (range, 5 to 14 cm), were treated; the mean graft length was of 8.3 cm. The bones involved were femur (4), radius (4), tibia (3) and humerus (3). In 5 cases fibula with its epiphysis was used, in 5 cases the flap was osteocutaneous and in the remaining 4 cases only fibula shaft was utilized. After an average time of 8 months from eradication of infection, the procedure was carried out and the flap was stabilized with external fixators, Kirschner's wires or mini-plate. No graft augmentation was used. Results. Total limb reconstruction was achieved in 13 of 14 cases. The average integration period was 3.5 months. The mean follow-up period was 20.7 months (range 22–43). Mean time for full weight bearing in reconstructed lower limb was 5.8 months. All patients were walking pain-free and none with a supportive device. The fibular flap with epiphysis had good functional outcomes. A few early and delayed complications were observed. Lengthening through one graft on the forearm was achieved and the radial length restored. Conclusions. In low resource setting, provided that the
Simulated learning is increasingly prevalent in many surgical training programs as medical education moves towards competency based curricula. In orthopaedic surgery, developmental dysplasia of the hip is a commonly treated diagnosis where the standard of care in patients less than six months of age is an orthotic device such as the Pavlik Harness. However, despite widespread use of the Pavlik Harness and the potential complications that may arise from inappropriate application, no formal educational methods exist. A video and model based simulated learning module for Pavlik Harness application was developed. Two novice groups (residents and allied health professionals) were exposed to the module and at pre-intervention, post-intervention and retention testing were evaluated on their ability to apply a Pavlik Harness to the model. Evaluations were completed using a previously validated Objective Structured Assessment of
Objectives:. To establish the demand, referral pathways, utility and patient satisfaction of a physiotherapy led post operative spinal surgery review clinic. Methods:. From July 2014 to January 2015 a pilot physiotherapy led clinic was established. The following clinic data was collected: number of patients reviewed, surgical procedure, outcome of clinic assessment, numbers requiring further investigation, numbers requiring review in the consultant led clinic and adverse events. A patient satisfaction survey was also administered to all English speaking patients. Patients were asked to rate the ease of getting through to the service by phone, length of wait, time spent with the clinician, answers to questions, explanation of results, advice about exercise and return to activities, the
Surgical training has been greatly affected by the challenges of reduced training opportunities, shortened working hours, and financial pressures. There is an increased need for the use of training system in developing psychomotor skills of the surgical trainee for fracture fixation. The training system was developed to simulate dynamic hip screw fixation. 12 orthopaedic senior house officers performed dynamic hip screw fixation before and after the training on training system. The results were assessed based on the scoring system that included the amount of time taken, accuracy of guide wire placement and the number of exposures requested to complete the procedure. The result shows a significant improvement in amount of time taken, accuracy of fixation and the number of exposures after the training on simulator system. This was statistically significant using paired student t-test (p-value <0.05). Computer navigated training system appears to be a good training tool for young orthopaedic trainees The system has the potential to be used in various other orthopaedic procedures for learning of
There has been a widespread adoption of training programs or “boot-camps” targeting new surgical residents prior to entrance to the hospital environment. A plethora of studies have shown positive reactions to implementations of “boot camps”. Reaction surveys, however, lack the ability to provide a deeper level of understanding into how and why “boot camps” are seen as effective. The purpose of this study was to develop a rich perspective on the role “boot camps” are perceived to play in resident education. A constructivist approach to qualitative grounded theory methodology, employing iterative semi-structured, in-person, interviews was used to explore the construct of a “boot camp” through the eyes of key stakeholders, including junior surgical residents (n=10), senior surgical residents (n=5), and faculty members (n=5) at a major academic centre. Interviews were coded and analysed thematically using NVIVO software. Three members of the research team coded data independently and compared themes until consensus was reached. A method of constant comparative analysis was utilised throughout the iterative process. Emerging themes were revisited with stakeholders as a measure of rigor. Axial coding of themes was used to discover the overlying purposes embedded in the “boot camp” construct. The overarching themes resonating from participants were ‘anxiety reduction’, ‘cognitive unloading’ and ‘practical logistics’. Resident anxiety was ameliorated through subthemes of ‘social inclusion’, ‘group formation’, ‘confidence building’ and ‘formalisation of expectations’. A resident commented “the nuances of how things work is more stressful than the actual job.” Residents bonded together to create personal and group identities, “forming the identity of who we are as a group”, that shaped ongoing learning throughout training, “right from the beginning we would be able to call on each other.” Junior residents found themselves cognitively unloaded for higher level learning through ‘expectation setting’ and ‘formalised basic skills’; “I knew how the equipment was going to fit together, it allowed me to focus more on what was happening from the operative perspective.” Stakeholders highlighted the importance of positioning “boot camp” at the beginning of residency training, as it directly influenced the point of transition. This highlights the strength of the “boot camp” construct at targeting the challenges associated with discrete moments of transition in the advancement in practice. While surgical preparatory “boot camps” were initially born out of a competency-based framework focused on
Aim: To investigate the capacity for retention of arthroscopic
