title: Ankle Arthroscopy Simulation Improves Basic Skills, Anatomic Recognition, and Proficiency During Diagnostic Examination of Residents in Training.
abstract: BACKGROUND
  The purpose of this study was to determine whether low-fidelity arthroscopic simulation training improves basic ankle arthroscopy performance and efficiency among orthopedic trainees.
  
  
  METHODS
  Twenty-nine orthopedic surgery trainees with varying levels of experience in ankle arthroscopy were randomized into either simulation or standard practice groups. At baseline testing, all participants performed simulator-based testing and a cadaveric diagnostic ankle arthroscopy with video recording. The simulation group subsequently received 4 one-on-one, 15-minute simulation training sessions over a 4-month period, while the standard practice group received no additional simulation training or exposure. After intervention, both groups were reevaluated with simulator testing and a second recorded cadaveric diagnostic ankle arthroscopy. Two blinded, independent experts evaluated each randomized arthroscopic performance using the 15-point checklist, Arthroscopic Surgery Skill Evaluation Tool (ASSET), and total elapsed time, and all outcome measures were compared within and between groups.
  
  
  RESULTS
  Baseline arthroscopic experience, simulator task performance measures, and ASSET scores were equivalent between the simulation and standard practice groups. After completion of training, the simulation group outscored the control group in total ASSET score (34.9 vs 19.6; P < .001) and checklist score (14.5 vs 8.4; P < .001) and achieved nearly expert ASSET Safety scores (4.7 vs 2.9; P < .001) on the simulator model. Cadaver testing also demonstrated significant improvements in total ASSET score (28.8 vs 16.8; P < .001), checklist score (12.6 vs 7.1; P < .001), and ASSET Safety score (3.9 vs 2.6; P < .001).
  
  
  CONCLUSIONS
  These results demonstrate that low-fidelity ankle arthroscopy simulation training can improve basic surgical skills, efficiency of movement, and anatomic recognition. The results suggest greater patient safety during ankle arthroscopy following simulation training.
  
  
  METHODS
  Level I, prospective comparative study.
authors.affiliation: Orthopaedic Surgery, University of Iowa Sports Medicine Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Dr.Kevin.D.Martin@gmail.com.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Martin
authors.affiliation: Orthopaedic Surgery, University of Iowa Sports Medicine Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Patterson
authors.affiliation: Orthopaedic Surgery, University of Iowa Sports Medicine Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.affiliation: The John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, US Military Academy, West Point, NY, USA.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Cameron
authors.affiliation: Orthopaedic Surgery, University of Iowa Sports Medicine Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Femino
authors.affiliation: Orthopaedic Surgery, University of Iowa Sports Medicine Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Annunziato
authors.initials: A
authors.lastname: Amendola
mesh_terms: D000843:Ankle Joint / Q000033:anatomy & histology* / Q000473:pathology; D001182:Arthroscopy / Q000193:education*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D019637:Orthopedic Procedures / Q000193:education*; D011446:Prospective Studies; D000066908:Simulation Training / Q000379:methods*
keywords: ankle; arthroscopic education; simulation