Published 6/1/2020
Kerri Fitzgerald

Simulated Training Technique Helps Residents Improve Arthroscopic Partial Meniscectomy Abilities

Editor’s note: The following content was published in the AAOS Now Special Edition and distributed in June 2020. The content was originally scheduled for the AAOS Now Daily Edition, which publishes each year onsite at the AAOS Annual Meeting but this year’s meeting in March was canceled due to COVID-19. Despite the cancellation, members can access virtual content from the Annual Meeting by visiting the Academy’s Annual Meeting Virtual Experience webpage.

A study assessed the use of a simulated training technique for arthroscopic partial meniscectomy for orthopaedic residents and found that it improved simulated proficiency. This successfully transferred to a real clinical scenario with a high model transfer ratio. Gerardo Ledermann, MD, from Santiago, Chile, author of the data that were presented as part of the Annual Meeting Virtual Experience, said that after simulated training, residents were “able to transfer this skill to a real operating room (OR) scenario with excellent clinical results.”

“I was encouraged to develop this study because, during my residency program, the only way we could develop surgical skills was in the real OR with patients,” said Dr. Ledermann. “Although this method is effective, in my opinion, it does not allow residents to really master each technical skill. The original idea was to demonstrate that simulated training is useful for learning and transferring skills to the OR, in order to incorporate a formal training program in residents’ education.”

The researchers designed an arthro-scopic partial meniscectomy training module and sought to determine its ability to teach residents skills they could transfer to real patients. A total of 11 junior orthopaedic residents (first and second year of training) and three expert knee surgeons were involved in the study.

A knee surgical simulator was used for all simulated stages. Trainees had two baseline evaluations upon completing partial midbody medial meniscectomies: one on the simulator and one on a real patient. Researchers used the previously validated Arthroscopic Surgical Skill Evaluation Tool (ASSET) to evaluate their performance.

After baseline, the trainees completed a 10-session training program and had a final evaluation of proficiency on the simulator. Trainees were measured with ASSET after a partial midbody medial meniscectomy on a real patient. The expert knee surgeons also were tested once on the simulator and once on real patients.

All trainees improved significantly from a median baseline ASSET of 10 points to a median final ASSET of 39 points (P < 0.01) on the simulator. On real patients, scores improved from 14 points at baseline to 36 points at final score (P < 0.01).

In addition, Dr. Ledermann noted, “After six months of no training or exposure to arthroscopic procedures, residents were able to maintain their skills as good as the last session of simulated training.”

Trainees’ final simulator scores did not differ from experts’ scores on the simulator (P < 0.01); however, trainees’ mean final score on real patients was lower than their mean final simulator score (36 versus 39 points respectively, P = 0.01), which resulted in a 92 percent transfer ratio for the model.

“This study is what we believe to be the first step into demonstrating that other types of simulated training are useful for transferring skills to the OR. We are now working on a new project in which we are replicating this study for osteotomies in the forefoot, with promising results,” Dr. Ledermann told AAOS Now.

The study is limited by its small patient population. In addition, Dr. Ledermann said, “Because every resident rotates in different specialties, it is very difficult to prohibit the exposure of arthroscopic surgery for those who are rotating in specialties such as shoulder and knee at the time of the study; therefore, at the beginning of the training sessions, the exposure of each resident was different.”

Dr. Ledermann’s coauthors of Poster 1008, “Can Orthopaedic Residents Transfer Knee Arthroscopic Abilities from the Simulator to the Operating Room? A Prospective Study,” are Pablo Besa, Andrés Rodrigo, and Sebastian Irarrazaval.

Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at kefitzgerald@aaos.org.