Efficacy and Validation of a Simulation-Based Compartment Syndrome Instructional Course

This study reports the validity and effectiveness of a simulation-based compartment syndrome instructional course.

Six post-graduation year one (PGY1) orthopaedic residents and six PGY5 residents participated in the study. All PGY1 residents participated in a four-hour compartment syndrome training simulation. An anatomic compartment model was used to test needle placement accuracy in four leg muscle compartments. Pre-training, immediate post-training, and one-month post-training performance data were collected from all PGY1 residents, as well as data from a onetime assessment of all PGY5 residents. These assessments included a paper test for lower leg anatomy (anatomy module), a procedural test of needle placement accuracy using an anatomic compartment syndrome simulation module (needle placement module), and an assessment of ability to measure compartment pressure via low cost simulation (pressure measurement module). Face validity of the needle placement module and pressure measurement module were assessed using a structured questionnaire given to all 12 study participants and three orthopaedic faculty.

The PGY1 residents demonstrated significant improvement at immediate post-training in all three assessments compared to their pre-training performances (anatomy p=0.019, needle placement p=0.026, pressure measurement p=0.033 and Objective Structured Assessment of Technical Skill (OSATS) score for pressure measurement p <0.0001). This performance was maintained at the one-month post-training assessment. Immediate post-training and one-month post-training PGY1 resident performances were comparable with PGY5 resident performance in all tests.Fifteen participants rated the face validity of the needle placement and pressure measurement modules. For the needle placement module, 73.3% of participants highly rated (4 out of 5 or greater) for realism, 86.7% highly rated for being an effective tool for teaching, and 80% highly rated for needing the model to be available throughout their training. The pressure measurement module did not receive high face validity ratings.

With minimal, inexpensive training, the performance of junior residents in a compartment syndrome simulation was improved to a level comparable with senior residents. In addition, this performance was maintained at one-month post-training. The compartment syndrome anatomic module had highly-rated face validity.

Training junior residents to accurately diagnose compartment syndrome using a realistic simulation may allow for greater diagnostic accuracy in the clinical setting.