Resident Education Two Pager - Simulation

Resident Education Two Pager - Simulation

Orthopaedic residency programs across the country use methods such as cadaver laboratory, Orthopaedic In-Training Examination and boards preparation, surgical experience, feedback and evaluations, and surgical simulation to educate their residents.However, no consensus exists on the best ways to utilize each of these educational practices.Therefore, the AAOS Resident Assembly set out to identify unique, high-performing practices for each of these methods. Using a nationwide resident survey and the Resident Education Forum at the 2017 AAOS Annual Meeting, we have identified ways in which residency programs can improve how residents are educated.At the end of this documentare summative highlights of best practices for surgical simulation.

With the continued development of technology and virtual reality, computer simulators have becomean important educational tool ina variety ofindustriessuch asaviationand the military.In the medical field, general surgery has begun using laparoscopic and endoscopic surgery simulators in the board certification process.The introduction of simulatorusein orthopaedic residencytraining began in earnestin July 2013 when the American Board of Orthopaedic Surgeons and the Residency Review Committee mandated 1 month of surgical skills training for all US orthopaedic interns.The suggested curriculum for this new rotation, which has 17modules covering many fields of orthopaedics, incorporatessimulator use and training. Though nascent in its use in orthopaedic surgery,surgical simulation training should provide a safe, inexpensive, and accessible means of improving basic orthopaedic skills for residents, and will evolve as technology improves and feedback is amassed.

Orthopaedic residents also see the importance of surgical simulation to benefit their training.In our nationwide resident survey, most residents reported that surgical simulation waseither “extremely important”or “very important”to their education (76%); few residents said that surgical simulation was “slightly important” or “not at all important” (4.7%).However, compared with this high level of perceived importance, only 58% of residents reported that their program did an excellent or above average job at providing surgical simulation training.

Infographic.The 2016 AAOS Resident Survey indicated that residents find surgical simulation a highly important aspect of their education

It is perhaps not surprising that this discrepancy between perceived importance and level of accomplishment exists, given the relatively new status of simulation in orthopaedic surgery.At the Resident Education Forum,mostresidents reported that the most substantial barrier to successful simulator training at their programs was lack of access.Many programs simply do not have a simulator or, if present, residents have limited ability to use the simulators due tolocation or time constraints.Importantly, the type of surgical simulator used by programs, when present, was not seen as a positive or negative aspect of a program’s simulation training program – rather, it was simply not having an accessible surgical simulator that was seen as a negative.

Residents from programs with access to a robust surgical simulation curriculumreported a direct correlation between their practice time on the simulator andimprovement in their surgical skills, particularly for arthroscopy.In addition to easy access to simulators regarding location and available times, residents also reported that the top-performing programs offered the ability to track one’s progress, such as by completing sequential modules.Last, residents stated that having specific curricular goals for the simulator for each rotation made the experience more educational and relevant to their current service.

One simulation center that was highlighted at the Forumwas the Northwestern Center for Advanced Surgical Education (N-CASE).N-CASE is a 5,200-ft2 laboratory space located on the Northwestern University medical campus, created through collaboration among multiple medical and surgical departments, all of which share the space.Given the center’s location and availability 24 hours per day, 7 days per week, residents find it highly accessible.Orthopaedic residents use the space to practice fundamental surgical skills on simulators during their intern surgical skills rotation,andupper-level residents use it to practice more advanced techniques.Residents report that the center is key for learning arthroscopic and surgical techniques related to spinal surgery.

The creation of a large, multidepartmentalsimulation center is not a feasible option for many orthopaedic surgery departments.Some programs, such as that at the University of Maryland, have integrated orthopaedic-specific simulators into the training of their residents.These haptic simulators, which provide tactile feedback, have been funded by educational grants and require less physical space than large simulation centers (Figure 2).At Maryland, residents use the simulators at least once per month and have unlimited access to the simulators,which are convenientlylocated in the resident library.These simulators provide training for arthroscopy, pedicle screw placement, and trauma techniques such as perfect circles, tibial nails, and femoral neck pinning.Each simulator station has a set of modules that allows residents to progress sequentially from a beginner to an advanced level.Residents say that the simulators provide great feedback for learning introductory and junior-level surgical skills.

Figure 2.A resident practices femoral neck screw insertion on a haptic surgical simulator at the University of Maryland (Photo credit: Dr. Matthew Christian)

With the incorporation of surgical simulation into the national orthopaedic residency curriculum, identifying best practices for simulator use in orthopaedic resident education has become an important pursuit.The single most important barrier is access to surgical simulators, which some programs have addressed through collaboration with other departments or by purchasing their own simulators via grants.In addition to ensuring access for their residents, high-performing simulator programs haverotation-specific goals and the ability to monitor resident progress(Figure 3).In the near future, it will be important to collect feedback and determine the optimal learning interfaces for orthopaedic surgical simulation.We hope that residency programs can use these ideas to find ways to create or improve their own surgical simulation offerings and, in doing so, improve resident education.

Summative Highlights

• Provide residents with access to surgical simulators
• Determine rotation-specific goals for residents to accomplish on the simulators
• Enable residents to track their progress and receive constructive feedback
• Consider collaboration with other departments, or other nearby orthopaedic residencies, to combine simulator resources

Note at bottom:

If you would like to share a unique practice for any educational topic, please contact the AAOS Resident Assembly at .