Surgical resident training has traditionally occurred in a master-apprentice-type relationship, with graduated responsibilities until trainees are expected to perform procedures on their own. Given recent changes in the health care system, including reduced operating room time, increased difficulty of procedures and working hour restrictions, there is less time for residents to learn using traditional methods.
Researchers from the University of Manitoba and the Pan Am Clinic recently published a paper in the journal Arthroscopy, Sports Medicine, and Rehabilitation that looked at the effectiveness of a mixed reality simulator for the training of arthroscopy novices. Following this study, the residency program has made it a requirement in the curriculum that residents in the sports rotation complete the self-learning modules.
Dr. Samuel Larrivée, one of the study's authors, stated that "sports surgeons at our institution noted anecdotally that junior residents had difficulty reaching competency in arthroscopic skills by the end of their three-month rotation, and were not as prepared when starting their senior rotation. There was a need to increase training opportunities outside of the operating room in order to prepare our residents for independent practice."
Prior to obtaining the ArthroS™ simulator from VirtaMed, the University of Manitoba Orthopedic Surgery program occasionally used simulation such as benchtop dry simulators, cadavers and an older generation simulator with active haptics. These were mostly used to complement academic teaching sessions in small groups with some success, and available for use by residents as needed. However, due to the low fidelity and difficult setup, few residents took up the opportunity.
Medical student engagement with the ArthroS simulator was different. Alisha Beaudoin, a co-author and medical student, attested to her experience using the ArthroS simulator in her early training. "I found this training to be very helpful during my surgery rotation. Many of my preceptors were impressed by my superior arthroscopic and laparoscopic skills. This training may allow students with an interest in surgery to be more prepared."
Recently, many Canadian universities have moved to competency-based curriculums where residents must demonstrate competency prior to moving to the next defined practice level. The study noted that this is similar to the training available on ArthroS and that "a user enrolled in the mentoring program is progressed through various levels of training by meeting training targets, essentially providing a proficiency-based progression."
This paper is the first in what the authors hope is a larger body of work on validating arthroscopy simulators for resident training. There are currently plans to repeat similar studies with the other modules (hip, shoulder, and ankle), with larger sample sizes, and at different levels of training.
The Study
Study participants were divided into three groups: simulator training only, mentor-based training, and a control. At the end of four weeks, surgical performance improved among both traditional and simulator-based training groups. The study concluded that "simulator training may provide enhanced skills to improve patient safety overall, as residents may become more skilled earlier in their training, leaving more time for the mentor to teach more advanced skills." Beaudoin further explains: "I believe that simulation training should be introduced into the standardized curriculum because I believe it offers a safe space to hone your skills and improve in a stress-free environment."
Based on the study results, residents are now required to complete the self-learning modules as part of training during their sports rotation. Certain modules have been identified at the junior and senior levels. Dr. Larrivée believes this will allow residents to develop their triangulation skills and memorize the steps prior to their first surgery and consolidate their knowledge.
