title: Training safer orthopedic surgeons. Construct validation of a virtual-reality simulator for hip fracture surgery.
abstract: OBJECTIVE
  Virtual-reality (VR) simulation in orthopedic training is still in its infancy, and much of the work has been focused on arthroscopy. We evaluated the construct validity of a new VR trauma simulator for performing dynamic hip screw (DHS) fixation of a trochanteric femoral fracture.
  
  
  METHODS
  30 volunteers were divided into 3 groups according to the number of postgraduate (PG) years and the amount of clinical experience: novice (1-4 PG years; less than 10 DHS procedures); intermediate (5-12 PG years; 10-100 procedures); expert (> 12 PG years; > 100 procedures). Each participant performed a DHS procedure and objective performance metrics were recorded. These data were analyzed with each performance metric taken as the dependent variable in 3 regression models.
  
  
  RESULTS
  There were statistically significant differences in performance between groups for (1) number of attempts at guide-wire insertion, (2) total fluoroscopy time, (3) tip-apex distance, (4) probability of screw cutout, and (5) overall simulator score. The intermediate group performed the procedure most quickly, with the lowest fluoroscopy time, the lowest tip-apex distance, the lowest probability of cutout, and the highest simulator score, which correlated with their frequency of exposure to running the trauma lists for hip fracture surgery.
  
  
  CONCLUSIONS
  This study demonstrates the construct validity of a haptic VR trauma simulator with surgeons undertaking the procedure most frequently performing best on the simulator. VR simulation may be a means of addressing restrictions on working hours and allows trainees to practice technical tasks without putting patients at risk. The VR DHS simulator evaluated in this study may provide valid assessment of technical skill.
authors.affiliation: a 1Department of Orthopaedics, Barts and the London, the Royal London Hospital, London.
authors.forename: Kashif
authors.initials: K
authors.lastname: Akhtar
authors.affiliation: b 2MSk Lab, Imperial College London, Charing Cross Hospital, Fulham, London.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sugand
authors.affiliation: c 3 Institute of Population Health , University of Manchester, Manchester.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sperrin
authors.affiliation: b 2MSk Lab, Imperial College London, Charing Cross Hospital, Fulham, London.
authors.forename: Justin
authors.initials: J
authors.lastname: Cobb
authors.affiliation: b 2MSk Lab, Imperial College London, Charing Cross Hospital, Fulham, London.|d 4 Postgraduate School of Surgery, London Deanery, London , UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Standfield
authors.affiliation: b 2MSk Lab, Imperial College London, Charing Cross Hospital, Fulham, London.
authors.forename: Chinmay
authors.initials: C
authors.lastname: Gupte
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000193:education*; D009985:Orthopedics / Q000193:education*; D014584:User-Computer Interface