Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking
Abstract
:1. Introduction
2. Materials and Methods
2.1. Digitally Enhanced Hands-On Surgical Training (DEHST)
2.2. Participants and Study Groups
2.3. Protocol and Construct Validity
2.4. Questionnaire and Face Validity
2.5. Statistical Analysis
3. Results
3.1. Participants
3.2. Face Validity
3.3. Construct Validity
4. Discussion
Methodological Considerations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Blumstein, G.; Zukotynski, B.; Cevallos, N.; Ishmael, C.; Zoller, S.; Burke, Z.; Clarkson, S.; Park, H.; Bernthal, N.; SooHoo, N.F. Randomized Trial of a Virtual Reality Tool to Teach Surgical Technique for Tibial Shaft Fracture Intramedullary Nailing. J. Surg. Educ. 2020, 77, 969–977. [Google Scholar] [CrossRef]
- Lewis, F.R.; Klingensmith, M.E. Issues in general surgery residency training—2012. Ann. Surg. 2012, 256, 553–559. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Williams, R.G.; Swanson, D.B.; Fryer, J.P.; Meyerson, S.L.; Bohnen, J.D.; Dunnington, G.L.; Scully, R.E.; Schuller, M.C.; George, B.C. How Many Observations are Needed to Assess a Surgical Trainee’s State of Operative Competency? Ann. Surg. 2019, 269, 377–382. [Google Scholar] [CrossRef] [PubMed]
- Bell, R.H.; Biester, T.W.; Tabuenca, A.; Rhodes, R.S.; Cofer, J.B.; Britt, L.D.; Lewis, F.R. Operative experience of residents in US general surgery programs: A gap between expectation and experience. Ann. Surg. 2009, 249, 719–724. [Google Scholar] [CrossRef] [PubMed]
- Svedahl, E.R.; Pape, K.; Toch-Marquardt, M.; Skarshaug, L.J.; Kaspersen, S.-L.; Bjørngaard, J.H.; Austad, B. Increasing workload in Norwegian general practice—A qualitative study. BMC Fam. Pract. 2019, 20, 68. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Győrffy, Z.; Dweik, D.; Girasek, E. Workload, mental health and burnout indicators among female physicians. Hum. Resour. Health 2016, 14, 12. [Google Scholar] [CrossRef] [Green Version]
- Winquist, R.A. Locked Femoral Nailing. J. Am. Acad. Orthop. Surg. 1993, 1, 95–105. [Google Scholar] [CrossRef] [PubMed]
- Gugala, Z.; Nana, A.; Lindsey, R.W. Tibial intramedullary nail distal interlocking screw placement: Comparison of the free-hand versus distally-based targeting device techniques. Injury 2001, 32, SD21–SD25. [Google Scholar] [CrossRef]
- Whatling, G.M.; Nokes, L.D.M. Literature review of current techniques for the insertion of distal screws into intramedullary locking nails. Injury 2006, 37, 109–119. [Google Scholar] [CrossRef]
- Kempf, I.; Grosse, A.; Beck, G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J. Bone Jt. Surg. Am. 1985, 67, 709–720. [Google Scholar] [CrossRef]
- Tyropoulos, S.; Garnavos, C. A new distal targeting device for closed interlocking nailing. Injury 2001, 32, 732–735. [Google Scholar] [CrossRef]
- Goodall, J.D. An image intensifier laser guidance system for the distal locking of an intramedullary nail. Injury 1991, 22, 339. [Google Scholar] [CrossRef]
- Goulet, J.A.; Londy, F.; Saltzman, C.L.; Matthews, L.S. Interlocking intramedullary nails. An improved method of screw placement combining image intensification and laser light. Clin. Orthop. Relat. Res. 1992, 281, 199–203. [Google Scholar] [CrossRef]
- Krettek, C.; Schandelmaier, P.; Tscherne, H. Distal femoral fractures. Transarticular reconstruction, percutaneous plate osteosynthesis and retrograde nailing. Unfallchirurg 1996, 99, 2–10. [Google Scholar] [PubMed]
- Pennig, D.; Oppenheim, W.; Faccioli, G.; Rossi, S. Intramedullary locked nailing of femur and tibia: Insertion of distal locking screws without image intensifier. Injury 1997, 28, 323–326. [Google Scholar] [CrossRef]
- Steriopoulos, K.A.; Kontakis, G.M.; Katonis, P.G.; Galanakis, I.A.; Dretakis, E.K. Placement of the distal locking screws of the femoral intramedullary nail without radiation. Arch. Orthop. Trauma. Surg. 1996, 115, 43–44. [Google Scholar] [CrossRef] [PubMed]
- Suhm, N.; Jacob, A.L.; Nolte, L.P.; Regazzoni, P.; Messmer, P. Surgical navigation based on fluoroscopy—Clinical application for computer-assisted distal locking of intramedullary implants. Comput. Aided Surg. 2000, 5, 391–400. [Google Scholar] [CrossRef] [PubMed]
- Slomczykowski, M.A.; Hofstetter, R.; Sati, M.; Krettek, C.; Nolte, L.P. Novel computer-assisted fluoroscopy system for intraoperative guidance: Feasibility study for distal locking of femoral nails. J. Orthop. Trauma 2001, 15, 122–131. [Google Scholar] [CrossRef] [PubMed]
- Malek, S.; Phillips, R.; Mohsen, A.; Viant, W.; Bielby, M.; Sherman, K. Computer assisted orthopaedic surgical system for insertion of distal locking screws in intra-medullary nails: A valid and reliable navigation system. Int. J. Med. Robot. 2005, 1, 34–44. [Google Scholar] [CrossRef]
- Yaniv, Z.; Joskowicz, L. Precise robot-assisted guide positioning for distal locking of intramedullary nails. IEEE Trans. Med. Imaging 2005, 24, 624–635. [Google Scholar] [CrossRef]
- Digitally Enhanced, Hands-on Surgical Training n.d. Available online: https://innovations.aofoundation.org/innovation-translation/technology-transfer/digitally-enhanced---hands-on-surgical-training (accessed on 24 March 2022).
- Windolf, M.; Richards, R.G. Generic Implant Positioning Technology Based on Hole Projections in X-Ray Images. J. Med. Device 2021, 15, 025002. [Google Scholar] [CrossRef] [PubMed]
- Buschbaum, J.; Windolf, M. Reference Device for Real-Time Tracking of Bone and/or Surgical Objects in Computer-Assisted Surgery. U.S. Patent Application 16/967,478, 8 June 2021. [Google Scholar]
- Medoff, R.J. Insertion of the distal screws in interlocking nail fixation of femoral shaft fractures. Technical note. J. Bone Jt. Surg. Am. 1986, 68, 1275–1277. [Google Scholar] [CrossRef]
- Kelley, S.S.; Bonar, S.; Hussamy, O.D.; Morrison, J.A. A simple technique for insertion of distal screws into interlocking nails. J. Orthop. Trauma 1995, 9, 227–230. [Google Scholar] [CrossRef] [PubMed]
- Rahm, S.; Germann, M.; Hingsammer, A.; Wieser, K.; Gerber, C. Validation of a virtual reality-based simulator for shoulder arthroscopy. Knee Surg. Sports Traumatol. Arthrosc. 2016, 24, 1730–1737. [Google Scholar] [CrossRef]
- Tuijthof, G.J.M.; Visser, P.; Sierevelt, I.N.; Van Dijk, C.N.; Kerkhoffs, G.M.M.J. Does perception of usefulness of arthroscopic simulators differ with levels of experience? Clin. Orthop. Relat. Res. 2011, 469, 1701–1708. [Google Scholar] [CrossRef] [Green Version]
- Stunt, J.J.; Kerkhoffs, G.M.M.J.; van Dijk, C.N.; Tuijthof, G.J.M. Validation of the ArthroS virtual reality simulator for arthroscopic skills. Knee Surg. Sports Traumatol. Arthrosc. 2015, 23, 3436–3442. [Google Scholar] [CrossRef] [Green Version]
- Bouaicha, S.; Jentzsch, T.; Scheurer, F.; Rahm, S. Validation of an Arthroscopic Training Device. Arthroscopy 2017, 33, 651–658.e1. [Google Scholar] [CrossRef]
- Srivastava, S.; Youngblood, P.L.; Rawn, C.; Hariri, S.; Heinrichs, W.L.; Ladd, A.L. Initial evaluation of a shoulder arthroscopy simulator: Establishing construct validity. J. Shoulder Elb. Surg. 2004, 13, 196–205. [Google Scholar] [CrossRef]
- de Steiger, R.N.; Lorimer, M.; Solomon, M. What is the learning curve for the anterior approach for total hip arthroplasty? Clin. Orthop. Relat. Res. 2015, 473, 3860–3866. [Google Scholar] [CrossRef] [PubMed]
- Fucentese, S.F.; Rahm, S.; Wieser, K.; Spillmann, J.; Harders, M.; Koch, P.P. Evaluation of a virtual-reality-based simulator using passive haptic feedback for knee arthroscopy. Knee Surg. Sports Traumatol. Arthrosc. 2015, 23, 1077–1085. [Google Scholar] [CrossRef]
- Tuijthof, G.J.M.; van Sterkenburg, M.N.; Sierevelt, I.N.; van Oldenrijk, J.; Van Dijk, C.N.; Kerkhoffs, G.M.M.J. First validation of the PASSPORT training environment for arthroscopic skills. Knee Surg. Sports Traumatol. Arthrosc. 2010, 18, 218–224. [Google Scholar] [CrossRef]
- Bayona, S.; Fernández-Arroyo, J.M.; Martín, I.; Bayona, P. Assessment study of insight ARTHRO VR (®) arthroscopy virtual training simulator: Face, content, and construct validities. J. Robot. Surg. 2008, 2, 151–158. [Google Scholar] [CrossRef]
- Cannon, W.D.; Eckhoff, D.G.; Garrett, W.E.; Hunter, R.E.; Sweeney, H.J. Report of a group developing a virtual reality simulator for arthroscopic surgery of the knee joint. Clin. Orthop. Relat. Res. 2006, 442, 21–29. [Google Scholar] [CrossRef] [PubMed]
- Gomoll, A.H.; Pappas, G.; Forsythe, B.; Warner, J.J.P. Individual skill progression on a virtual reality simulator for shoulder arthroscopy: A 3-year follow-up study. Am. J. Sports Med. 2008, 36, 1139–1142. [Google Scholar] [CrossRef]
- Mabrey, J.D.; Reinig, K.D.; Cannon, W.D. Virtual reality in orthopaedics: Is it a reality? Clin. Orthop. Relat. Res. 2010, 468, 2586–2591. [Google Scholar] [CrossRef] [Green Version]
- McCarthy, A.D.; Hollands, R.J. A commercially viable virtual reality knee arthroscopy training system. Stud. Health Technol. Inform. 1998, 50, 302–308. [Google Scholar] [PubMed]
- Meyer, R.D.; Tamarapalli, J.R.; Lemons, J.E. Arthroscopy training using a “black box” technique. Arthroscopy 1993, 9, 338–340. [Google Scholar] [CrossRef]
- Müller, W.; Bockholt, U.; Lahmer, A.; Voss, G.; Börner, M. VRATS—Virtual Reality Arthroscopy Training Simulator. Radiologe 2000, 40, 290–294. [Google Scholar] [CrossRef] [PubMed]
- O’Neill, P.J.; Cosgarea, A.J.; Freedman, J.A.; Queale, W.S.; McFarland, E.G. Arthroscopic proficiency: A survey of orthopaedic sports medicine fellowship directors and orthopaedic surgery department chairs. Arthroscopy 2002, 18, 795–800. [Google Scholar] [CrossRef]
- Pedowitz, R.A.; Esch, J.; Snyder, S. Evaluation of a virtual reality simulator for arthroscopy skills development. Arthroscopy 2002, 18, E29. [Google Scholar] [CrossRef] [Green Version]
Question | Agree | Disagree | Undecided |
---|---|---|---|
1. The training simulator is useful for procedural training of distal nail interlocking | 53 (100) | 0 (0) | 0 (0) |
2. The training simulator (distal interlocking) should be offered to all novices for pre-training before performing surgery on real patients | 47 (89) | 0 (0) | 6 (11) |
3. The training simulator (distal interlocking) should be obligatory for pre-training novices before performing surgery on real patients | 32 (60) | 9 (23) | 12 (17) |
4. The training simulator (distal interlocking) should be recommended for any orthopaedic trauma resident to improve his/her skills individually | 50 (94) | 0 (0) | 3 (6) |
5. The training simulator (distal interlocking) should be integrated into the current curriculum of the specialization program of orthopaedic surgeons (e.g., FMH, Facharzt) | 28 (53) | 11 (21) | 14 (26) |
6. There are certain disadvantages in the simulator training method. Please specify: | 18 (34) | 14 (26) | 21 (40) |
7. I would like to have the simulator in my institution | 51 (96) | 0 (0) | 2 (4) |
8. I would recommend the simulator to my colleagues | 52 (98) | 0 (0) | 1 (2) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Pastor, T.; Pastor, T.; Kastner, P.; Souleiman, F.; Knobe, M.; Gueorguiev, B.; Windolf, M.; Buschbaum, J. Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking. Medicina 2022, 58, 773. https://doi.org/10.3390/medicina58060773
Pastor T, Pastor T, Kastner P, Souleiman F, Knobe M, Gueorguiev B, Windolf M, Buschbaum J. Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking. Medicina. 2022; 58(6):773. https://doi.org/10.3390/medicina58060773
Chicago/Turabian StylePastor, Torsten, Tatjana Pastor, Philipp Kastner, Firas Souleiman, Matthias Knobe, Boyko Gueorguiev, Markus Windolf, and Jan Buschbaum. 2022. "Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking" Medicina 58, no. 6: 773. https://doi.org/10.3390/medicina58060773