Editor's Spotlight/Take 5: Do Skills Acquired from Training with a Wire Navigation Simulator Transfer to a Mock Operating Room Environment?

Abstract

Surgical education is frustrating. I don't mean that it’s hard to keep residents away from the popliteal artery during knee replacement (though sometimes they do seem rather determined to hit it). I’m talking about the fact that surgical education may have more in common with the guild system that enabled the professional formation of saddlemakers in medieval Italy than it does with, say, pilot training in the 21st century. Pure coincidence that there were 14 lesser guilds in classical Florence [2] and there are 14 surgical subspecialties [1]? I hope so. Regardless, the quality of flight simulation vastly exceeds that of surgical simulation, and I’m not just talking about tools available to sharpen the skills of fighter pilots who want to land on pitching carrier decks at night, or even commercial pilots who fly 737s for Delta Airlines. A private pilot—a hobbyist, paying for simulator time with a credit card at a few bucks an hour—has better technology to help her improve his crosswind landings in a 40-year-old Cessna than does an orthopaedic resident at most university programs today who is trying to improve her surgical skills. This is frustrating. Happily, in this month’s Clinical Orthopaedics and Related Research, a research group from the University of Iowa, led by Donald D. Anderson PhD, demonstrated the efficacy of what they call a wire navigation simulator they developed, testing it in a mock operating room environment [5]. Wire navigation is a key surgical skill for orthopaedic trainees because it is used in so many diverse procedures (like hip fracture surgery, tension-band wiring, and many pediatric trauma applications), and because the skills required to manipulate a wire in three dimensions in advance of placing a cannulated screw may also generalize to other procedures that don’t use wires but do require three-dimensional aptitude, like arthroscopic surgery. Dr. Anderson’s team evaluated three approaches to surgical training: Simple pedagogy with didactic training, deliberate practice (didactics plus some relatively unsupervised training with the simulator, which gives helpful, specific feedback to its users), and proficiency training. The latter included all of the interventions from the two previous groups, plus supervised, hands-on skills testing in the simulator that required demonstration of proficiency with simpler tasks before moving on to more-advanced ones. In a bit of perhaps unexpected good news, residents allocated to self-study in the simulator (deliberate practice) did as well those who underwent moreintensive proficiency training on some of the more-important endpoints, including achieving correct tip-apex distance for simulated hip fracture surgery [5]. What was most impressive to me about this study was the level of A note from the Editor-In-Chief: In “Editor’s Spotlight,” one of our editors provides brief commentary on a paper we believe is especially important and worthy of general interest. Following the explanation of our choice, we present “Take 5,” in which the editor goes behind the discovery with a oneon-one interview with an author of the article featured in “Editor’s Spotlight.” Donald D. Anderson PhD is a partial owner of a company (Iowa Simulation Solutions LLC) that manufactures the simulator mentioned in this manuscript, but no financial payments were received during the period of this study. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This comment refers to the article available at: DOI: 10.1097/CORR.0000000000000799. S. S. Leopold MD (✉), Clinical Orthopaedics and Related Research, 1600 Spruce St., Philadelphia, PA 19013 USA, Email: sleopold@clinorthop.org