title: Performance of medical students on a virtual reality simulator for knee arthroscopy: an analysis of learning curves and predictors of performance.
abstract: BACKGROUND
  Ethical concerns for surgical training on patients, limited working hours with fewer cases per trainee and the potential to better select talented persons for arthroscopic surgery raise the interest in simulator training for arthroscopic surgery. It was the purpose of this study to analyze learning curves of novices using a knee arthroscopy simulator and to correlate their performance with potentially predictive factors.
  
  
  METHODS
  Twenty medical students completed visuospatial tests and were then subjected to a simulator training program of eight 30 min sessions. Their test results were quantitatively correlated with their simulator performance at initiation, during and at the end of the program.
  
  
  RESULTS
  The mean arthroscopic performance score (z-score in points) at the eight test sessions were 1. -35 (range, -126 to -5) points, 2. -16 (range, -30 to -2), 3. -11 (range, -35 to 4), 4. -3 (range, -16 to 5), 5. -2 (range, -28 to 7), 6. 1 (range, -18 to 8), 7. 2 (range, -9 to 8), 8. 2 (range, -4 to 7). Scores improved significantly from sessions 1 to 2 (p = 0.001), 2 to 3 (p = 0.052) and 3 to 4 (p = 0.001) but not thereafter. None of the investigated parameters predicted performance or development of arthroscopic performance.
  
  
  CONCLUSIONS
  Novices improve significantly within four 30 min test virtual arthroscopy knee simulator training but not thereafter within the setting studied. No factors, predicting talent or speed and magnitude of improvement of skills could be identified.
authors.affiliation: Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland. stefan_rahm@yahoo.com.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rahm
authors.affiliation: Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Wieser
authors.affiliation: Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
authors.forename: Ilhui
authors.initials: I
authors.lastname: Wicki
authors.affiliation: Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
authors.forename: Livia
authors.initials: L
authors.lastname: Holenstein
authors.affiliation: Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
authors.forename: Sandro F
authors.initials: SF
authors.lastname: Fucentese
authors.affiliation: Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D000066908:Simulation Training; D013337:Students, Medical; D014584:User-Computer Interface
keywords: Education; Knee arthroscopy; Learning curve; Predictive factors; Virtual reality