Virtual-reality simulation to assess performance in hip fracture surgery.
OBJECTIVE
Internal fixation of hip fractures is a common and important procedure that orthopedic surgeons must master early in their career. Virtual-reality training could improve initial skills, and a simulation-based test would make it possible to ensure basic competency of junior surgeons before they proceed to supervised practice on patients. The aim of this study was to develop a reliable and valid test with credible pass/fail standards.


METHODS
20 physicians (10 untrained novices and 10 experienced orthopedic surgeons) each performed 3 internal fixation procedures of an undisplaced femoral neck fracture: 2 hook-pins, 2 screws, and a sliding hip screw. All procedures were preformed on a trauma simulator. Performance scores for each procedure were obtained from the predefined metrics of the simulator. The inter-case reliability of the simulator metrics was explored by calculation of intra-class correlation coefficient. Validity was explored by comparison between novices' and experts' scores using independent-samples t-test. A pass/fail standard was set by the contrasting-groups method and the consequences were explored.


RESULTS
The percentage of maximum combined score (PM score) showed an inter-case reliability of 0.83 (95% CI: 0.65-0.93) between the 3 procedures. The mean PM score was 30% (CI: 7-53) for the novices and 76% (CI: 68-83) for the experienced surgeons. The pass/fail standard was set at 58%, resulting in none of the novices passing the test and a single experienced surgeon failing the test.


CONCLUSIONS
The simulation-based test was reliable and valid in our setting, and the pass/fail standard could discriminate between novices and experienced surgeons. Potentially, training and testing of future junior surgeons on a virtual-reality simulator could ensure basic competency before proceeding to supervised practice on patients.
Department of Orthopaedic Surgery , Hospital of Nykøbing F.
Poul
P
Pedersen
Henrik
H
Palm
Charlotte
C
Ringsted
Lars
L
Konge
D000328:Adult; D001858:Bone Nails; D001863:Bone Screws; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods / Q000592:standards; D003198:Computer Simulation; D004521:Educational Measurement / Q000379:methods / Q000592:standards; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000193:education*; D014584:User-Computer Interface