The internal validity of arthroscopic simulators and their effectiveness in arthroscopic education
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The purpose of this systematic review was to identify standard procedures for the validation of arthroscopic simulators and determine whether simulators improve the surgical skills of users.
Arthroscopic simulator validation studies and randomized trials assessing the effectiveness of arthroscopic simulators in education were identified from online databases, as well as, grey literature and reference lists. Only validation studies and randomized trials were included for review. Study heterogeneity was calculated and where appropriate, study results were combined employing a random effects model.
Four hundred and thirteen studies were reviewed. Thirteen studies met the inclusion criteria assessing the construct validity of simulators. A pooled analysis of internal validation studies determined that simulators could discriminate between novice and experts, but not between novice and intermediate trainees on time of completion of a simulated task. Only one study assessed the utility of a knee simulator in training arthroscopic skills directly and demonstrated that the skill level of simulator-trained residents was greater than non-simulator-trained residents.
Excessive heterogeneity exists in the literature to determine the internal and transfer validity of arthroscopic simulators currently available. Evidence suggests that simulators can discriminate between novice and expert users, but discrimination between novice and intermediate trainees in surgical education should be paramount. International standards for the assessment of arthroscopic simulator validity should be developed to increase the use and effectiveness of simulators in orthopedic surgery.
Level of evidence
Diagnostic study, Level III.
KeywordsArthroscopic simulators Virtual reality Validation Surgical education
Conflict of interest
- 1.Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA III, Ramel S, Smith CD, Arvidsson D (2007) Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 193(6):797–804PubMedCrossRefGoogle Scholar
- 10.Farnworth LR, Lemay DE, Wooldridge T, Mabrey JD, Blaschak MJ, DeCoster TA, Wascher DC, Schenck RC Jr (2001) A comparison of operative times in arthroscopic ACL reconstruction between orthopaedic faculty and residents: the financial impact of orthopaedic surgical training in the operating room. Iowa Orthop J 21:31–35PubMedCentralPubMedGoogle Scholar
- 18.James PB, Hope SH-B, Mark WS (2005) Determining the efficacy of an immersive trainer for arthroscopy skills. In: MMVR13, Amsterdam, Netherlands, 1999. Medicine meets virtual reality. The magical next becomes the medical now. IOS press, pp 54–56Google Scholar
- 21.McCarthy A, Harley P, Smallwood R Virtual arthroscopy training: do the virtual skills developed match the real skills required? In: MMVR 7, Amsterdam, Netherlands, 1999. Medicine meets virtual reality. Convergence of physical and informational technologies: Options for a New Era in Healthcare. IOS Press, pp 221–227Google Scholar
- 23.Megali G, Tonet O, Mazzoni M, Dario P, Vascellari A, Marcacci M (2002) A new tool for surgical training in knee arthroscopy. In: Proceedings of the part II, Berlin, Germany, 2002. Medical image computing and computer-assisted intervention—MICCAI 2002. 5th international conference. Springer, pp 170–177Google Scholar
- 27.Review Manager (RevMan) [Computer program] (2011) Version 5.1. Copenhagen: The Nordic Cochrane Centre, The cochrane collaborationGoogle Scholar