Evaluation of skill level between trainees and community orthopaedic surgeons using a virtual reality arthroscopic knee simulator.
BACKGROUND
Several virtual reality simulators have been developed to assist orthopaedic surgeons in acquiring the skills necessary to perform arthroscopic surgery. The purpose of this study was to assess the construct validity of the ArthroSim virtual reality arthroscopy simulator by evaluating whether skills acquired through increased experience in the operating room lead to improved performance on the simulator.


METHODS
Using the simulator, six postgraduate year-1 orthopaedic residents were compared with six postgraduate year-5 residents and with six community-based orthopaedic surgeons when performing diagnostic arthroscopy. The time to perform the procedure was recorded. To ensure that subjects did not sacrifice the quality of the procedure to complete the task in a shorter time, the simulator was programmed to provide a completeness score that indicated whether the surgeon accurately performed all of the steps of diagnostic arthroscopy in the correct sequence.


RESULTS
The mean time to perform the procedure by each group was 610 seconds for community-based orthopaedic surgeons, 745 seconds for postgraduate year-5 residents, and 1028 seconds for postgraduate year-1 residents. Both the postgraduate year-5 residents and the community-based orthopaedic surgeons performed the procedure in significantly less time (p = 0.006) than the postgraduate year-1 residents. There was a trend toward significance (p = 0.055) in time to complete the procedure when the postgraduate year-5 residents were compared with the community-based orthopaedic surgeons. The mean level of completeness as assigned by the simulator for each group was 85% for the community-based orthopaedic surgeons, 79% for the postgraduate year-5 residents, and 71% for the postgraduate year-1 residents. As expected, these differences were not significant, indicating that the three groups had achieved an acceptable level of consistency in their performance of the procedure.


CONCLUSIONS
Higher levels of surgeon experience resulted in improved efficiency when performing diagnostic knee arthroscopy on the simulator. Further validation studies utilizing the simulator are currently under way and the additional simulated tasks of arthroscopic meniscectomy, meniscal repair, microfracture, and loose body removal are being developed.
Department of Orthopaedic Surgery, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158. E-mail address: cannond@orthosurg.ucsf.edu.
W Dilworth
WD
Cannon
Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642.
Gregg T
GT
Nicandri
Department of Cell and Developmental Biology, Colorado School of Medicine, 12801 East 17th Avenue, MS 8108, Aurora, CO 80045.
Karl
K
Reinig
CME Course Operations and Practice Management, American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018.
Howard
H
Mevis
Bassett Shoulder and Sports Medicine Research Institute, Bassett Healthcare Network, 1 Atwell Road, Cooperstown, NY 13326.
Jocelyn
J
Wittstein
D001182:Arthroscopy / Q000193:education* / Q000295:instrumentation; D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007719:Knee Joint / Q000601:surgery*; D059032:Learning Curve; D008953:Models, Anatomic; D009657:North Carolina; D009985:Orthopedics / Q000193:education*; D012495:San Francisco; D013997:Time Factors; D014584:User-Computer Interface