Validating low-fidelity arthroscopic simulation in medical students: a feasibility trial

Abstract

Introduction: With surgical opportunities becoming increasingly restricted for orthopaedic trainees, simulation training is a valuable alternative at providing sufficient practice. This pilot study aims to assess the potential effectiveness of low-fidelity simulation in teaching medical students basic arthroscopic skills and the feasibility of its incorporation into formal student training programmes.

Methods: Twenty-two medical students completed pre- and post-training tests on the Probing (Task 1) and Maze (Task 2) exercises from the Sawbones 'Fundamentals of Arthroscopy Surgery Training' (FAST) programme. Training consisted of practising horizon control, deliberate linear motion and probing within 25min over a period of days. Completion time and error frequency were measured. The difference in performance was assessed using a paired two-tailed t-test. Qualitative data were collected.

Results: Test completion time decreased significantly by a mean of 83s (±46s, 95% confidence intervals [CI] 37 to 129) for Task 1 (p=0.001) and 105s (±55s, 95% CI 50 to 160) for Task 2 (p=0.0007). Frequency of direct visualisation errors decreased significantly by a mean of 1.0 errors (±1.0 errors, 95% CI 0.1 to 2.0) for Task 1 (p = 0.04) and 0.8 errors (±0.8 errors, 95% CI 0.1 to 1.6) for Task 2 (p = 0.04). At post-training, 82% of participants were willing to incorporate FAST into formal training.

Conclusions: Low-fidelity simulators such as FAST can potentially teach basic arthroscopic skills to medical students and are feasible for incorporation into formal training. They also give students a cost-effective and safe basic surgical training experience.

Keywords: Arthroscopy; Orthopaedic procedures; Orthopaedics; Simulation training.

Figure 1

Medical student performing Task 2 (Maze exercise)

Figure 2

View of the probing platform in Task 1 visualised using the Supereyes 7mm USB 0° endoscope

Figure 3

View of the maze in Task 2 visualised using the Supereyes 7mm USB 0° endoscope

Figure 4

Time to completion in pre- and post-training tests, with error bars indicating standard deviation

Figure 5

Number of direct visualisation errors made in pre- and post-training tests, with error bars indicating standard deviation

Figure 6

Scatter plot showing correlation between number of direct visualisation errors and reduction in test completion time for Task 1

Figure 7

Scatter plot showing correlation between number of direct visualisation errors and reduction in test completion time for Task 2

Figure 8

Participant responses to incorporating FAST into medical students’ orthopaedic rotations