Testing basic competency in knee arthroscopy using a virtual reality simulator: exploring validity and reliability.

Area of Science:

• Orthopaedic Surgery
• Medical Simulation
• Surgical Education

Background:

• Diagnostic knee arthroscopy is a core skill for orthopaedic residents.
• Many residents lack confidence in arthroscopic procedures compared to open surgery.
• Virtual reality (VR) simulation offers a controlled environment for training and assessment.

Purpose of the Study:

• To develop and validate a VR simulation test for basic knee arthroscopy competency.
• To establish a reliable pass-or-fail standard for this simulation-based assessment.
• To evaluate the feasibility of using VR simulation for resident training.

Main Methods:

• Twenty-six surgeons (13 novices, 13 experienced) performed four arthroscopic knee procedures on a VR simulator.
• Performance was measured using simulator metrics and converted to z-scores.
• Intercase reliability was assessed using intraclass correlation coefficients.
• A pass-or-fail standard was determined using the contrasting groups method.

Main Results:

• The VR simulation test demonstrated high intercase reliability (0.87).
• Novices had significantly higher mean z-scores (38.6) than experienced surgeons (0.0) (p < 0.0005).
• A pass-or-fail threshold of 15.5 z-score points was established, with 2 novices passing and 1 experienced surgeon failing.

Conclusions:

• A VR simulation combining four procedures provides a valid, reliable, and feasible method for assessing basic arthroscopic competency.
• This simulation-based test and pass-or-fail standard can help ensure resident readiness for patient procedures.
• VR simulation is a valuable tool for standardizing and improving surgical training in arthroscopy.