title: Surgical simulators and hip fractures: a role in residency training?
abstract: BACKGROUND
  Orthopedic surgery residency training requires intellectual and motor skill development. In this study, we utilized a computer-based haptic simulator to examine a potential model for evaluation of resident proficiency and efficiency in the placement of a center guide wire during fixation of an intertrochanteric proximal femur fracture. We hypothesize the junior residents will utilize more fluoroscopy and require more time to complete the task.
  
  
  METHODS
  Postgraduate year (PGY) 1-5 residents completed the same task of placing a single central guide pin into a femoral head for a dynamic hip screw construct utilizing a haptic surgical simulator. Residents were divided into 2 groups (PGY 1-2 and PGY 3-5) and then evaluated based on final tip-apex distance (TAD), fluoroscopy time, time to complete the task, total number of distinct attempts at pin placement for each femur construct, as well as final 3-dimensional location of the pin from the isometric center of the femoral head.
  
  
  RESULTS
  No statistically significant differences were noted between the 2 groups in total time or for tip-apex distance, anterior/posterior medial/lateral position, anterior/posterior superior/inferior, and lateral x-ray medial/lateral positioning measurements. Significant differences between Groups I and II were observed in anterior/posterior final position on the lateral view (p = 0.01), unique attempts (0.77 and 1.5, p = 0.03), and total fluoroscopic time (18.4 seconds and 12.9 seconds, p = 0.05).
  
  
  CONCLUSIONS
  In this study, we displayed that based on our simulator model there was no statistical difference between Group I and II in time to completion, final placement on anterior/posterior (A/P) view, and tip-apex distance. There was a statistically significant difference in the anterior/posterior placement of the wire in lateral view between the 2 groups, fluoroscopy time, and number of attempts per trial. Our findings suggest a computer-based surgical simulator can identify measurable differences in surgical proficiency between junior and senior orthopedic surgery residents and may play an expanding role in resident education.
authors.affiliation: Division of Orthopaedic Surgery and Rehabilitation, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9679, USA. jmilbrandt@siumed.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Froelich
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Milbrandt
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Novicoff
authors.forename: Khaled J
authors.initials: KJ
authors.lastname: Saleh
authors.forename: D Gordon
authors.initials: DG
authors.lastname: Allan
mesh_terms: D000328:Adult; D001858:Bone Nails; D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D005270:Femur Head / Q000601:surgery; D005471:Fluoroscopy; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D019637:Orthopedic Procedures / Q000193:education*; D012494:Sampling Studies