Virtual reality assessment of technical skill using the Bonedoc DHS simulator

The Bonedoc DHS simulator is a virtual reality simulator of screw and plate fixation of hip fractures which runs on a standard PC. We hypothesised that the simulator would be able to discriminate between subjects with different levels of operative experience. Three groups (medical students (MSs), basic trainees (BTs), and advanced trainees (ATs)) performed six virtual operations. Measurements included: reduction position, incision length, misplaced drill-holes, final screw placement, X-rays taken, surgical time as well as computer and operative experience. The accuracy, number of X-rays and speed were significantly different between novices and trainee surgeons (p<0.01, p<0.05, p<0.05). Intra-articular screw penetration by the medical students occurred 12 times, basic trainees 6 times and advanced trainees twice (p<0.01, MS vs. trainees). Amongst trainees, the advanced trainees placed the lag screw more accurately and took less X-rays (ns). The basic trainees performed the complete procedure fastest at 6 min compared to ATs at 9 min (p<0.05) but were not as accurate. The Bonedoc DHS simulator provides a means to discriminate between novices and trainee surgeons.