title: Construct Validity, Assessment of the Learning Curve, and Experience of Using a Low-Cost Arthroscopic Surgical Simulator.
abstract: OBJECTIVE
  We have developed a low-cost, portable shoulder simulator designed to train basic arthroscopic skills. This study aimed to establish the construct validity of the simulator by determining which parameters discriminated between experience levels and to assess the experience of using the simulator.
  
  
  METHODS
  Participants were given an introductory presentation and an untimed practice run of a 6-step triangulation task using hooks and rubber bands. A total of 6 consecutive attempts at the task were timed, and the number of times the participant looked at their hands during the task was recorded. Participants then completed a questionnaire on their experience of using the simulator.
  
  
  METHODS
  St George's Hospital, London and the South West London Elective Orthopaedic Centre, Surrey.
  
  
  METHODS
  Medical students, trainee doctors and surgeons, and consultant surgeons were approached to use the simulator. Participation was voluntary and nonincentivized. In total, 7 orthopedic consultants, 12 trainee doctors (ranging from foundation year 1 to clinical fellow post-Certificate of Completion of Training), and 9 medical students were recruited.
  
  
  RESULTS
  The average time for medical students to complete the task was 161 seconds, compared to 118 seconds for trainees, and 84 seconds for consultants. The average fastest time for medical students was 105 seconds, 73 seconds for trainees, and 52 seconds for consultants. Students were significantly slower than trainees (p = 0.026) and consultants (p = 0.001). However, times did not differ significantly between trainees and consultants. Consultants looked at their hands 0.7 times on average during the task compared with 2.8 and 3.4 times for trainees and students, respectively. More than 95% of participants found the exercise interesting and agreed or strongly agreed that the simulator was easy to use, easily portable, and well designed and constructed.
  
  
  CONCLUSIONS
  This study has established construct validity of the simulator by demonstrating the ability to distinguish between surgical experience levels. The learning curve shows improvement in individuals with or without arthroscopic or surgical experience. Simulation is becoming increasingly important in the training of medical students and surgical trainees; this study has established that low-cost portable arthroscopic box trainers may play a significant role.
authors.affiliation: St George's University of London, London, United Kingdom.
authors.forename: Henry B
authors.initials: HB
authors.lastname: Colaco
authors.affiliation: St George's University of London, London, United Kingdom. Electronic address: katiephughes@gmail.com.
authors.forename: Katie
authors.initials: K
authors.lastname: Hughes
authors.affiliation: St George's University of London, London, United Kingdom.
authors.forename: Eyiyemi
authors.initials: E
authors.lastname: Pearse
authors.affiliation: St George's University of London, London, United Kingdom.
authors.forename: Magnus
authors.initials: M
authors.lastname: Arnander
authors.affiliation: St George's University of London, London, United Kingdom.
authors.forename: Duncan
authors.initials: D
authors.lastname: Tennent
mesh_terms: D000328:Adult; D020679:Arthroscopes / Q000191:economics*; D001182:Arthroscopy / Q000193:education*; D002983:Clinical Competence; D017046:Cost Savings; D004503:Education, Medical, Graduate / Q000191:economics / Q000379:methods; D004504:Education, Medical, Undergraduate / Q000191:economics / Q000379:methods; D004521:Educational Measurement; D004867:Equipment Design; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D000066908:Simulation Training / Q000191:economics* / Q000379:methods; D006113:United Kingdom; D055815:Young Adult
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; arthroscopy; simulation; surgery; training