Putting a Number on Performance

Independent Study Combines Proficiency-based Training Assessments.

The journal Arthroscopy recently published a study conducted at New York’s Hospital for Special Surgery (HSS) which evaluated the comparability of the traditional Arthroscopic Surgery Skills Evaluation Tool (ASSET) with the metrics-based assessments of a virtual reality simulator (the VirtaMed ArthroS™ hip module). The study was conducted at the HSS Bioskills Education Laboratory which is available to residents and other trainees at HSS to learn and practice different surgical procedures. The article is based upon two-years’ worth of research gathered between 2017-2019 and involving 30 participants who ranged from novice to expert.

According to the study, arthroscopy education is a good candidate for medical simulation given the “steep learning curve that requires the development of proficient psychomotor skills, which are difficult to obtain without continuous hands-on practice.” There has been renewed interest in medical simulation for arthroscopy training given the limitations to hands-on practice due to restrictions in the surgical residents working hours, the expense and limited usability of cadavers, and the reduction in elective procedures due to Covid-19. Dr. Gabriella Ode, an orthopedic sports medicine surgeon and one of the article’s authors, noted that she had used simulation as a learning tool both during her residency training at Carolinas Medical Center and at the Hospital for Special Surgery where she was a fellow. She found that simulation was particularly helpful as a junior resident for becoming more familiar with specific procedure steps in arthroscopy. She concluded that:

“I believe there is a role for simulation training for arthroscopy. Arthroscopy is a skill set that has a different learning curve for every surgeon. For some people that is 1-2 practice sessions while for others it can be 20 or 50. Every trainee should be afforded the opportunity to independently practice arthroscopy in a setting that allows for safe repetitions that help fine tune psychomotor skills. Simulation offers that.”

According to Dr. Ode, the study emerged from the authors’ understanding that:

“There is a need to incorporate surgical skills training and objective assessment. The ASSET has a growing role as a validated assessment tool that can be used in simulation, cadaver training, and in the live surgical setting. Having a consistent tool for assessment allows for trainees and teachers to determine the efficacy of our simulation curriculum in creating measurable growth in our development of surgical skills.”

While virtual reality simulation is relevant for all areas of arthroscopy, this is particularly true for the hip, due to the complexity of the procedure, limited numbers of elective cases on which to train, and on the procedures’ relative newness as an arthroscopic option.

The study found that the “VirtaMed hip arthroscopy simulator, the ArthroS™, demonstrated good construct validity and excellent reliability for simulator-based metrics and ASSET score.” The authors further noted that these findings are clinically relevant because virtual reality arthroscopy simulators are becoming more commonplace and that “an evaluation of the most effective objective and subjective measures of performance is necessary in order to optimize simulation training.” In this case, that means that new “simulators should be validated as an accurate measure of clinical performance” exactly as this study did for the ArthroS™. This knowledge will help in the development of future training curricula with hip arthroscopy simulators “because it provides baseline objectives for training and sets expectations for step-wise progression as trainees gain arthroscopy experience.”

Read more about the study here

About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 11th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2020-2021), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2020-2021). HSS is ranked world #1 in orthopedics by Newsweek (2020-2021). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

About VirtaMed

VirtaMed is the world leader in data-driven medical education, using mixed reality simulators for minimally invasive diagnostic and therapeutic interventions in orthopaedics, urology, ob/gyn and general surgery. Combining virtual reality graphics with original instruments and anatomic models for realistic tactile feedback, VirtaMed partners with medical societies, medical device companies and teaching institutions.