A review of the role of simulation in developing and assessing orthopaedic surgical skills

Abstract

Orthopaedic surgical skill is traditionally acquired during training in an apprenticeship model that has been largely unchanged for nearly 100 years. However, increased pressure for operating room efficiency, a focus on patient safety, work hour restrictions, and a movement towards competency-based education are changing the traditional paradigm. Surgical simulation has the potential to help address these changes. This manuscript reviews the scientific background on skill acquisition and surgical simulation as it applies to orthopaedic surgery. It argues that simulation in orthopaedics lags behind other disciplines and focuses too little on simulator validation. The case is made that orthopaedic training is more efficient with simulators that facilitate deliberate practice throughout resident training and more research should be focused on simulator validation and the refinement of skill definition.

Figure 1. The relationship between level of expertise in violinists and the accumulated hours of deliberate practice. From Ericsson, et al., used with permission

Figure 2. Haptic force-feedback shown in orthopaedic drilling simulation. (Left) Tsai and Tsai, (middle) Froelich, et al., and (right) Vankipuram, et al., each used with permission

Figure 3. (top) Schematic of images seen by trainee during procedure showing intercept with center of femoral head. (bottom) The implant as viewed after the procedure highlighting 3D placement of screw. From Blyth, Stott and Anderson, used with permission

Figure 4. An example of a commercial product featuring a Fundamentals of Laparoscopic training simulator. Figure courtesy of VTI Medical™