The effect of computer navigation on trainee learning of surgical skills.
BACKGROUND
While computer-assisted orthopaedic surgery technology may facilitate performance and learning in the expert, its effects on the trainee are unclear. Motor learning theory suggests that, while the real-time feedback provided by computer-assisted orthopaedic surgery should improve performance, it may be detrimental to learning. The purpose of this study was to assess the effects of computer-assisted orthopaedic surgery on the learning of surgical skills by trainees.


METHODS
Forty-five participants were randomized to one of three training groups-conventional training, computer navigation, or knowledge of results-in which they learned technical skills related to total hip replacement. Outcomes were assessed in a pretest session and in ten-minute and six-week retention and transfer tests.


RESULTS
All groups demonstrated improved accuracy and precision in the determination of the abduction angle and the version angle of the acetabular cups during training (p < 0.001). The computer navigation group demonstrated significantly better accuracy and precision in early training (p < 0.05) and better precision throughout training (p < 0.05). No significant degradation in performance was observed between the immediate and the delayed testing for any group, suggesting that there was task learning in all groups with no negative effects of the tested training modalities on learning.


CONCLUSIONS
In this study, the concurrent augmented feedback provided by computer-assisted orthopaedic surgery resulted in improved early performance and equivalent learning. While we did not observe a compromise in learning, further investigation is required to ensure that computer-assisted orthopaedic surgery does not compromise trainee learning in more complex tasks.
Gofton
Wade
W
The Ottawa Hospital - Civic Campus, 1053 Carling Avenue, Suite 2178, Ottawa, ON K1Y 4E9, Canada. wgofton@ottawahospital.on.ca
Dubrowski
Adam
A
Tabloie
Farshid
F
Backstein
David
D
D019644:Arthroplasty, Replacement, Hip / Q000193:education; D002983:Clinical Competence; D004311:Double-Blind Method; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005246:Feedback; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007858:Learning; D009985:Orthopedics / Q000193:education*; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000193:education*