title: Arthroscopic Shoulder Surgical Simulation Training Curriculum: Transfer Reliability and Maintenance of Skill Over Time.
abstract: BACKGROUND
  Surgical education is evolving as work hour constraints limit the exposure of residents to the operating room. Potential consequences may include erosion of resident education and decreased quality of patient care. Surgical simulation training has become a focus of study in an effort to counter these challenges. Previous studies have validated the use of arthroscopic surgical simulation programs both in vitro and in vivo. However, no study has examined if the gains made by residents after a simulation program are retained after a period away from training.
  
  
  METHODS
  In all, 17 orthopedic surgery residents were randomized into simulation or standard practice groups. All subjects were oriented to the arthroscopic simulator, a 14-point anatomic checklist, and Arthroscopic Surgery Skill Evaluation Tool (ASSET). The experimental group received 1 hour of simulation training whereas the control group had no additional training. All subjects performed a recorded, diagnostic arthroscopy intraoperatively. These videos were scored by 2 blinded, fellowship-trained orthopedic surgeons and outcome measures were compared within and between the groups. After 1 year in which neither group had exposure to surgical simulation training, all residents were retested intraoperatively and scored in the exact same fashion. Individual surgical case logs were reviewed and surgical case volume was documented.
  
  
  RESULTS
  There was no difference between the 2 groups after initial simulation testing and there was no correlation between case volume and initial scores. After training, the simulation group improved as compared with baseline in mean ASSET (p = 0.023) and mean time to completion (p = 0.01). After 1 year, there was no difference between the groups in any outcome measurements.
  
  
  CONCLUSIONS
  Although individual technical skills can be cultivated with surgical simulation training, these advancements can be lost without continued education. It is imperative that residency programs implement a simulation curriculum and continue to train throughout the academic year.
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas.
authors: John C
authors: JC
authors: Dunn
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas.
authors: Philip J
authors: PJ
authors: Belmont
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas.
authors: Joseph
authors: J
authors: Lanzi
authors: Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, Colorado.
authors: Kevin
authors: K
authors: Martin
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas.
authors: Julia
authors: J
authors: Bader
authors: Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, New York.
authors: Brett
authors: B
authors: Owens
authors: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, Texas. Electronic address: dunnjohnc@gmail.com.
authors: Brian R
authors: BR
authors: Waterman
mesh_terms: D001182:Arthroscopy / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D006801:Humans; D007396:Internship and Residency; D011446:Prospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D000066908:Simulation Training; D016037:Single-Blind Method; D013997:Time Factors
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; arthroscopy; shoulder; simulation; surgical training; transfer validity