title: Validating Touch Surgery™: A cognitive task simulation and rehearsal app for intramedullary femoral nailing.
abstract: BACKGROUND
  The role of simulation in orthopaedic surgical training is becoming increasingly evident, as simulation allows repeated sustained practice in an environment that does not harm the patient. Previous studies have shown that the cognitive aspects of surgery are of equal if not greater importance in developing decision making than the practical aspects.
  
  
  OBJECTIVE
  To observe construct, content and face validity of four IFN modules on a cognitive simulator, Touch Surgery™.
  
  
  METHODS
  39 novices and 10 experts were recruited to complete four simulation modules on surgical decision-making that represented the procedural steps of preparing the patient and equipment, inserting and locking an intramedullary femoral nail. Real-time objective performance metrics were obtained, stored electronically and analysed using median and Bonett-Price 95% confidence intervals from the participant's primary attempt to assess for construct validity. The median score of a post-study questionnaire using 5-point Likert scales assessed face and content validity. Data was confirmed as non-parametric by the Kolmogorov-Smirnov test. Significance was calculated using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. Significance was set as 2-tailed p-value<0.05.
  
  
  RESULTS
  Experts significantly outperformed novices in all four modules to demonstrate construct validity (p<0.001). Specifically, experts scored 32.5% higher for patient positioning and preparation (p<0.0001), 31.5% higher for femoral canal preparation (p<0.0001), 22.5% higher for proximal locking (p<0.0001) and 17% higher scores for distal locking and closure (p<0.001). Both cohorts either agreed or strongly agreed that the graphics, simulated environment and procedural steps were realistic. Also, both cohorts agreed that the app was useful for surgical training and rehearsal, should be implemented within the curriculum and would want to use it to learn other surgical procedures.
  
  
  CONCLUSIONS
  IFN on the Touch Surgery app demonstrated construct, face and content validity. Users can demonstrate cognitive competencies prior to performing surgical procedures in the operating room. The application is an effective adjunct to traditional learning methods and has potential for curricular implementation.
authors.affiliation: MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London, W6 8RF, UK. Electronic address: ks704@ic.ac.uk.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sugand
authors.affiliation: MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London, W6 8RF, UK. Electronic address: mala.mawkin13@imperial.ac.uk.
authors.forename: Mala
authors.initials: M
authors.lastname: Mawkin
authors.affiliation: MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London, W6 8RF, UK. Electronic address: c.gupte00@ic.ac.uk.
authors.forename: Chinmay
authors.initials: C
authors.lastname: Gupte
mesh_terms: D001842:Bone and Bones / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards*; D003071:Cognition; D003198:Computer Simulation; D005594:Fracture Fixation, Intramedullary / Q000193:education*; D006801:Humans; D009985:Orthopedics / Q000193:education*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014584:User-Computer Interface
keywords: Education; Intramedullary femoral nailing; Orthopaedic; Simulation; Touch surgery; Training; Trauma