Shoulder Arthroscopy Simulator Training Improves Surgical Procedure Performance: A Controlled Laboratory Study

Background: Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures. Purpose/Hypothesis: To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair. It was hypothesized that both DL and VR simulation methods would improve procedure performance; however, VR simulation would be more effective based on the validated Arthroscopic Surgery Skill Evaluation Tool (ASSET) Global Rating Scale. Study Design: Controlled laboratory study. Methods: Enrolled in the study were 38 orthopaedic residents at a single institution, postgraduate years (PGYs) 1 to 5. Each resident completed a pretest shoulder stabilization procedure on a cadaveric model and was then randomized into 1 of 2 groups: VR or DL simulation. Participants then underwent a 4-week arthroscopy simulation program and completed a posttest. Sports medicine–trained orthopaedic surgeons graded the participants on completeness of the surgical repair at the time of the procedure, and a single, blinded orthopaedic surgeon, using the ASSET Global Rating Scale, graded participants’ arthroscopy skills. The procedure step and ASSET grades were compared between simulator groups and between PGYs using paired t tests. Results: There was no significant difference between the groups in pretest performance in either the procedural steps or ASSET scores. Overall procedural step scores improved after combining both types of simulator training ( P = .0424) but not in the individual simulation groups. The ASSET scores improved across both DL ( P = .0045) and VR ( P = .0003), with no significant difference between the groups. Conclusion: A 4-week simulation program can improve arthroscopic skills and performance during a specific surgical procedure. This study provides additional evidence regarding the benefits of simulator training in orthopaedic surgery for both novice and experienced arthroscopic surgeons. There was no statistically significant difference between the VR and DL models, which disproved the authors’ hypothesis that the VR simulator would be the more effective simulation tool. Clinical Relevance: There may be a role for simulator training in the teaching of arthroscopic skills and learning of specific surgical procedures.

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Otoskills training during covid-19 pandemic: a before-after study

BMC Medical Education ◽

10.1186/s12909-021-02706-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maxime Fieux ◽

Antoine Gavoille ◽

Fabien Subtil ◽

Sophie Bartier ◽

Stéphane Tringali

Keyword(s):

Surgical Training ◽

Rating Scale ◽

Surgical Simulation ◽

Global Rating Scale ◽

Middle Ear Surgery ◽

Global Rating ◽

Training Requirements ◽

Significant Difference ◽

Before And After ◽

Total Performance

Abstract Background The ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator. Methods In this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively. Results Six out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40–0.64], p < 0.001), without a significant difference between novice and intermediate residents. Conclusions This preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

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Validation of a Global Rating Scale for Shoulder Arthroscopy: A Pilot Study

Shoulder & Elbow ◽

10.1111/j.1758-5740.2011.00153.x ◽

2012 ◽

Vol 4 (1) ◽

pp. 16-21 ◽

Cited By ~ 9

Author(s):

Antonia C. Hoyle ◽

Christopher Whelton ◽

Rowena Umaar ◽

Lennard Funk

Keyword(s):

Pilot Study ◽

Rating Scale ◽

Shoulder Arthroscopy ◽

Global Rating Scale ◽

Global Rating

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Objective Assessment of Technical Skills in Otorhinolaryngology–Head and Neck Surgery Residents: A Systematic Review

Otolaryngology ◽

10.1177/0194599817729826 ◽

2017 ◽

Vol 158 (1) ◽

pp. 54-61 ◽

Cited By ~ 2

Author(s):

Érika Mercier ◽

Ségolène Chagnon-Monarque ◽

François Lavigne ◽

Tareck Ayad

Keyword(s):

Head And Neck ◽

Surgical Procedures ◽

Rating Scale ◽

Reliability And Validity ◽

Neck Surgery ◽

Evaluation Methods ◽

Head And Neck Surgery ◽

Assessment Tools ◽

Global Rating Scale ◽

Global Rating

Objectives The primary goal is the indexation of validated methods used to assess surgical competency in otorhinolaryngology–head and neck surgery (ORL-HNS) residents. Secondary goals include assessment of the reliability and validity of these tools, as well as the documentation of specific procedures in ORL-HNS involved. Data Sources MEDBASE, OVID, Medline, CINAHL, and EBM, as well as the printed references, available through the Université de Montréal library. Review Methods The PRISMA method was used to review digital and printed databases. Publications were reviewed by 2 independent reviewers, and selected articles were fully analyzed to classify evaluation methods and categorize them by procedure and subspecialty of ORL-HNS involved. Reliability and validity were assessed and scored for each assessment tool. Results Through the review of 30 studies, 5 evaluation methods were described and validated to assess the surgical competency of ORL-HNS residents. The evaluation method most often described was the combined Global Rating Scale and Task-Specific Checklist tool. Reliability and validity for this tool were overall high; however, considerable data were unavailable. Eleven distinctive surgical procedures were studied, encompassing many subspecialties of ORL-HNS: facial plastics, general ear-nose-throat, laryngology, otology, pediatrics, and rhinology. Conclusions Although assessment tools have been developed for an array of surgical procedures, involving most ORL-HNS subspecialties, the use of combined checklists has been repeatedly validated in the literature and shown to be easily applicable in practice. It has been applied to many ORL-HNS procedures but not in oncologic surgery to date.

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Effect of Eccentric Exercise Program for Early Tibialis Posterior Tendinopathy

Foot & Ankle International ◽

10.3113/fai.2009.0877 ◽

2009 ◽

Vol 30 (9) ◽

pp. 877-885 ◽

Cited By ~ 38

Author(s):

Kornelia Kulig ◽

Eric S. Lederhaus ◽

Steve Reischl ◽

Shruti Arya ◽

Greg Bashford

Keyword(s):

Rating Scale ◽

Early Stage ◽

Case Series ◽

Exercise Program ◽

Global Rating Scale ◽

Tibialis Posterior ◽

Global Rating ◽

Level Of Evidence ◽

Time Points ◽

Significant Difference

Background: Morphology and vascularization of painful tibialis posterior (TP) tendons before and after an intervention targeting the degenerated tendon were examined. Functional status and pain level were also assessed. Materials and Methods: A10-week twice daily, progressive eccentric tendon loading, calf stretching program with orthoses was implemented with ten, early stage TP tendinopathy subjects. TP tendons were imaged by grayscale and Doppler ultrasound at INITIAL and POST evaluations to assess the tendon's morphology and signs of neovascularization. The Foot Functional Index (FFI), Physical Activity Scale (PAS), 5-Minute Walk Test, and single heel raise (SHR) test were completed at INITIAL and POST evaluations. The Global Rating Scale (GRS) was completed at 6 months followup. One-way ANOVA was used to compare the FFI at INITIAL, POST, and 6-MONTH time points. Paired t-tests were used to compare means between the remaining variables. The level of significance was p = 0.05. Results: There was a significant difference in FFI total, pain, and disability at the three time-points. Post-hoc paired t-tests revealed that the FFI scores were lower for the total score and pain and disability subcategories when comparing from INITIAL to POST and INITIAL to 6-MONTH evaluations ( p < 0.05 for all). The number of SHR increased significantly on the involved side from INITIAL to POST evaluation ( p = 0.041). The GRS demonstrated minimum clinically important differences for improvements in symptoms at 6-MONTH. Tendon morphology and vascularization remained abnormal following the intervention. Conclusion: A 10-week tendon specific eccentric program resulted in improvements in symptoms and function without changes in tendon morphology or neovascularization. Level of Evidence: IV, Case Series

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Perioperative mental status assessment of patients undergoing general surgical procedures

International Surgery Journal ◽

10.18203/2349-2902.isj20183192 ◽

2018 ◽

Vol 5 (8) ◽

pp. 2788

Author(s):

Prem Kumar A. ◽

Raksha Nadig ◽

Shashikala V. ◽

Vikram Arunachalam

Keyword(s):

Mental Status ◽

Surgical Procedures ◽

Surgical Procedure ◽

Rating Scale ◽

Psychological Status ◽

Low Mood ◽

Number Of Patients ◽

Significant Difference ◽

Psychiatric Rating ◽

Psychiatric Rating Scale

Background: The past few decades have seen an enormous increase in the number of patients undergoing curative and palliative surgical procedures. The objective of the present study was to assess the mental status in a patient undergoing a general surgical procedure perioperatively.Methods: 105 patients admitted in a surgical ward, posted to undergo an elective surgical procedure were evaluated to assess their psychological status. Each patient was subjected to a Brief Psychiatric Rating Scale questionnaire twice, once preoperatively and postoperatively. Both sessions were conducted in a calm environment and the patient was administered adequate analgesia to eliminate bias due to pain. The preoperative and postoperative scores were calculated and compared.Results: BPRS is a psychiatric rating scale used in various psychiatric conditions. Using this scale, we were able to detect the presence of a baseline low mood in a patient undergoing a surgical procedure. The average score preoperatively was 35.84 and postoperatively was 32.68. These scores were higher in patients undergoing surgeries for malignant conditions and also in those with co-morbid conditions like diabetes mellitus. Although there was an improvement in the postoperative scores, there was no significant difference between the preoperative and postoperative scores.Conclusions: A surgical procedure puts a patient through immense psychological stress manifested as low mood and reduced motivation on the part of the patient to participate in their own rehabilitation programme. This affects the overall outcome of a surgical procedure and increases the morbidity. Knowledge of this on part of the operating surgeon and thus proper counselling of the patient, addressing both the psychological and surgical aspects of the disease process will help improve the overall surgical experience.

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Fiberoptic Oral Intubation

Anesthesiology ◽

10.1097/aln.0b013e31818d6c3c ◽

2008 ◽

Vol 109 (6) ◽

pp. 1007-1013 ◽

Cited By ~ 77

Author(s):

Deven B. Chandra ◽

Georges L. Savoldelli ◽

Hwan S. Joo ◽

Israel D. Weiss ◽

Viren N. Naik

Keyword(s):

Virtual Reality ◽

Operating Room ◽

Rating Scale ◽

Training Model ◽

Educational Interventions ◽

Global Rating Scale ◽

High Fidelity ◽

Global Rating ◽

Significant Difference ◽

Better Than

Background Previous studies have indicated that fiberoptic orotracheal intubation (FOI) skills can be learned outside the operating room. The purpose of this study was to determine which of two educational interventions allows learners to gain greater capacity for performing the procedure. Methods Respiratory therapists were randomly assigned to a low-fidelity or high-fidelity training model group. The low-fidelity group was guided by experts, on a nonanatomic model designed to refine fiberoptic manipulation skills. The high-fidelity group practiced their skills on a computerized virtual reality bronchoscopy simulator. After training, subjects performed two consecutive FOIs on healthy, anesthetized patients with predicted "easy" intubations. Each subject's FOI was evaluated by blinded examiners, using a validated global rating scale and checklist. Success and time were also measured. Results Data were analyzed using a two-way mixed design analysis of variance. There was no significant difference between the low-fidelity (n = 14) and high-fidelity (n = 14) model groups when compared with the global rating scale, checklist, time, and success at achieving tracheal intubation (all P = not significant). Second attempts in both groups were significantly better than first attempts (P < 0.001), and there was no interaction between "fidelity of training model" and "first versus second attempt" scores. Conclusions There was no added benefit from training on a costly virtual reality model with respect to transfer of FOI skills to intraoperative patient care. Second attempts in both groups were significantly better than first attempts. Low-fidelity models for FOI training outside the operating room are an alternative for programs with budgetary constraints.

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The ASSET Global Rating Scale is a Valid and Reliable Adjunct Measure of Performance on a Virtual Reality Simulator for Hip Arthroscopy.

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.01.046 ◽

2021 ◽

Author(s):

Meghan E. Bishop ◽

Gabriella E. Ode ◽

Daniel Hurwit ◽

Stephan Zmugg ◽

Ryan Rauck ◽

...

Keyword(s):

Virtual Reality ◽

Hip Arthroscopy ◽

Rating Scale ◽

Global Rating Scale ◽

Global Rating ◽

Virtual Reality Simulator ◽

Measure Of Performance

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Objective structured assessment of technical skill in temporal bone dissection: validation of a novel tool

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001201 ◽

2021 ◽

pp. 1-11

Author(s):

M Stavrakas ◽

G Menexes ◽

S Triaridis ◽

P Bamidis ◽

J Constantinidis ◽

...

Keyword(s):

Temporal Bone ◽

Rating Scale ◽

Assessment Tool ◽

Three Dimensional ◽

Technical Skills ◽

Technical Skill ◽

Global Rating Scale ◽

Global Rating ◽

Validity And Reliability ◽

Cortical Mastoidectomy

Abstract Objective This study developed an assessment tool that was based on the objective structured assessment for technical skills principles, to be used for evaluation of surgical skills in cortical mastoidectomy. The objective structured assessment of technical skill is a well-established tool for evaluation of surgical ability. This study also aimed to identify the best material and printing method to make a three-dimensional printed temporal bone model. Methods Twenty-four otolaryngologists in training were asked to perform a cortical mastoidectomy on a three-dimensional printed temporal bone (selective laser sintering resin). They were scored according to the objective structured assessment of technical skill in temporal bone dissection tool developed in this study and an already validated global rating scale. Results Two external assessors scored the candidates, and it was concluded that the objective structured assessment of technical skill in temporal bone dissection tool demonstrated some main aspects of validity and reliability that can be used in training and performance evaluation of technical skills in mastoid surgery. Conclusion Apart from validating the new tool for temporal bone dissection training, the study showed that evolving three-dimensional printing technologies is of high value in simulation training with several advantages over traditional teaching methods.

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