Shoulder arthroscopy simulator performance correlates with resident and shoulder arthroscopy experience

Abstract

Background: The technical skills required to perform arthroscopy are multifaceted and require supervised training and repetition. Obtaining this basic arthroscopic skill set can be costly and time-consuming. Simulation may represent a viable training source for basic arthroscopic skills. Our goal was to evaluate the correlation between timed task performance on an arthroscopic shoulder simulator and both resident experience and shoulder arthroscopy experience.

Methods: Twenty-seven residents were voluntarily recruited from an orthopaedic residency program. Each subject was tested annually for three consecutive years on an arthroscopic shoulder simulator and objectively scored on time to completion of a standardized object localization task. Each subject's total number of shoulder arthroscopies, all arthroscopies, and cases were calculated according to postgraduate year from their Accreditation Council for Graduate Medical Education (ACGME) case log. Generalized estimating equation multivariate regression analysis was performed to determine the correlation between simulation performance and total numbers of shoulder arthroscopies, all arthroscopies, and cases.

Results: Univariate analyses revealed that postgraduate year, total number of shoulder arthroscopies, total number of arthroscopies of any joint, and total number of surgical cases performed during residency training prior to testing were associated with the mean time required to complete the simulator task. The number of prior shoulder arthroscopies performed (r = 0.55) and postgraduate year in training (r = 0.60) correlated most strongly with simulator basic task performance. In the multivariate analysis, the number of prior shoulder arthroscopies and postgraduate year remained independent predictors of faster completion of the simulator task. For every additional postgraduate year, there was a sixteen-second improvement in the time required to complete the simulator task (p < 0.005). Similarly, after controlling for the influence of postgraduate year, there was a twelve-second decrease in the time to complete the simulator task for every additional fifty shoulder arthroscopies performed during residency training (p < 0.008).

Conclusions: These results showed a significant relationship between performance of basic arthroscopic tasks in a simulator model and the number of shoulder arthroscopies performed. The data confirmed our hypothesis that simulator performance is representative of both resident experience and shoulder arthroscopy experience.

Clinical relevance: This study suggests that greater resident clinical experience and shoulder arthroscopy experience are both reflected in improved performance of basic tasks on a shoulder simulator. These findings warrant further investigation to determine if training on a validated arthroscopic shoulder simulator would improve clinical arthroscopic skills.