The Residency Review Committee in general surgery highly recommends that this curriculum be adopted by general surgery training programs. The American Board of Surgery requires passing the Fundamentals of Laparoscopic Surgery program65-66 (Fig. 4) as a basic skills competency for their certification and recertification programs in general surgery. There is no fundamental barrier preventing orthopaedics from adopting similar practices, except for the lack of validated surgical simulation training and assessment approaches.
Blyth and co-workers have developed a highly idealized virtual reality training system (Fig. 3) for basic hip fracture fixation, including a surgical simulator and an assessment component52-53. Concurrent validity measures the extent to which the simulator agrees with an existing performance measure of a surgical task or procedure. The concurrent validity of surgical simulators is often assessed by comparing simulator scores with the Objective Structured Assessment of Technical Skill or against another, previously validated, simulator. It is frequently difficult and often impossible to assess transfer of learning when attempting to validate educational simulation technology16. The most convincing evidence is provided when researchers can correlate performance on the simulator with real world performance.
There are simply not enough in-game hours to reach the expert batting level. In a ArcSoft PhotoStudio batting cage a player can hit 50 balls in five minutes, the equivalent of playing four consecutive games. Simulation could supplement apprenticeship training by enabling residents to effectively practice more in less time. Sometimes I like clipping the full yoke and throttle setup to my desk and really getting into the simulation. But it’s just as easy to plug in an Xbox controller, stream my PC to the TV, and play it on the couch. That’s a remarkable thing to say about a hardcore flight simulator, but a good example of how Microsoft Flight Simulator is more open and accessible than it’s ever been.
Although these changes threaten the amount of time residents have to practice surgical skills, it does not necessarily follow that their competency will decrease. Some practice is more effective at increasing skills than others, so the number of hours of practice may not be the most reliable measure of skill acquisition. To borrow a sports analogy, a baseball player comes up to bat three to four times a game. During each at-bat, the player sees an average of four pitches. This means in a game that averages nearly three hours, a batter sees roughly pitches.
Ultimately, a new simulator should pass multiple validity tests in order to be considered for skills training and competency assessment31. ” It refers to the subjective opinion about a test – its appropriateness for the intended use within the target population. Face validity is important for a test’s practical utility and success of implementation32, particularly with respect to whether or not trainees will accept the simulation as a valid educational tool. Face validity is usually assessed with expert responses to questionnaires or surveys. A primary factor motivating programs to search for new, more efficient surgical training methods is a 2003 ACGME-mandated reduction in residents’ work hours to a maximum of 80 hours per week.
A 2010 review of virtual reality simulators for orthopaedic surgery50 found only 23 articles that dealt with specific simulators, compared with 246 citations for laparoscopic simulators. Most of the other recent contributions to orthopaedic simulation technology have emphasized haptic feedback. Several such systems have been built to simulate drilling27, 29, and to simulate the forces in amputation surgery51. Other simulators emphasizing 3D graphics over haptics have enjoyed some success.