A Technological Chip on my Shoulder - Surgical Training with Simulators

Authors: Lennard Funk

References: Journal of Biomechanics. 43: S7-P10. 2010

We live in an age of rapidly advancing computer and information technology, alongside technological advancements in medical treatments. These are fully utilised in direct patient care, but lagging behind in the education of our future surgeons. Surgical skills are still taught mostly on living patients. In the past last half-decade we have worked, along with others, on developing and validating psychometric training tools and computer simulators for arthroscopic surgical training1.

The aims of our research programme have been to develop and validate simple online psychometric skills training and assessment tools, as well as validate a new arthroscopic surgical simulator for shoulder and knee surgery.

1. Online psychometric tools: We developed five online Flash-based training tools for hand-eye co-ordination and correlated these with different arthroscopic surgical skills3.

2. Computer Simulator studies: The Insight Arthro VR (GMV, Spain) is a computer surgical skill simulator for arthroscopic shoulder and knee surgery. Basic surgical skills and procedures can be performed on the simulator, with advanced feedback on surgical technique. We have undertaken studies to validate the simulator against the standard plastic surgical skills models and shoulder arthroscopic surgery2.

3. Online remote Global Rating Scale: We developed an online tool for uploading videos of surgical arthroscopic videos with an adapted global rating scale for the assessment of the quality of the surgical procedure by an independent expert. The system has been validated, assessing intra- and inter-observer accuracy4.

1. Navigation score correlated significantly with 4 Flash tests scores. Instrumentation score only significantly correlated with 1 Flash test score. We also found that non-string instrument players performed significantly better than string instrument players (p=0.033) at instrumentation. Other groups (computer gamers, crafters, drummers, right handedness) performed faster than their corresponding groups in all skills, but not significantly.

2. A significant correlation was found between the triangulation skills at shoulder arthroscopy and the palpation modules of the surgical simulator. Feedback from students training on plastic models and the computer simulator was that the simulator seemed more realistic, provided better feedback and was more enjoyable.

3. Initial results from validation of an online remote global rating scale have shown this to be a useful tool with an intra-class correlation coefficient value of 0.517. The scale does identify poorer performance more accurately and reliably than higher performing arthroscopies, but does require further construct validity studies and refinement before it can be practically used.

It appears that there is a role of online interactive psychometric tests in predicting an individuals ability to arthroscopic navigation and instrumentation. The tools we have developed correlate well with arthroscopic navigation, which is the primary skill required for arthroscopic surgery. Our results show that certain hobbies and demographics may have a role in predetermining the skills required for shoulder arthroscopic surgery.

The Insight Arthro VR appears to be an excellent tool for training arthroscopic surgeons, with excellent feedback and good correlation with pre-existing models.

An online remote global rating scale for assessing the surgical skills of a surgeon is appealing and with further work will hopefully assist with revalidation and skills assessment of surgeons.

There is much work still to be done, but we hope that these technological advances will assist and enhance the selection, training and assessment of future surgeons.

1.    Funk L. Using Technology to help train surgeons of the Future. Health Global Marketing. Vol 1:35-39. 2009.
2.    Funk L, Umaar R, Awan, A, Gandhi M. Computer Simulation Training for arthroscopic Surgey. Tameside Medical Journal. 1(3):5-8. 2007.
3.    M Gandhi & L Funk. An Apt Solution - Surgical Selection for arthroscopic Surgery - Surgeons News, Issue 5.4. 2006.
4.    R Umaar, M Ganghi, L Funk. Validation of an internet-based preconditioner training tool for shoulder arthroscopy - 14th Annual Residents & Fellows arthroscopy Conference, Useppa Island, Florida, USA, May 10th - 12th, 2007

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