Hip-fracture osteosynthesis training: exploring learning curves and setting proficiency standards

Area of Science:

• Orthopedic Surgery
• Medical Simulation
• Surgical Education

Background:

• Internal fixation of proximal femoral fractures is a core skill for orthopedic surgeons.
• Inexperienced trainees face challenges, leading to prolonged surgery and higher reoperation rates.
• Simulation-based virtual reality (VR) training offers a potential solution to accelerate the learning curve.

Purpose of the Study:

• To determine the necessary duration of VR simulation training for novice orthopedic surgeons.
• To establish a pass/fail mastery-learning standard for junior trainees in fracture fixation.
• To analyze learning curves for both novices and experts in simulated surgical procedures.

Main Methods:

• 38 first-year residents and 8 orthopedic trauma consultants performed simulated internal fixation procedures (cannulated screws, Hansson pins, sliding hip screw) on the Swemac TraumaVision VR simulator.
• Participants repeated procedures until reaching a learning plateau.
• A previously validated assessment test was used to evaluate performance.

Main Results:

• Novices reached their learning plateau after an average of 169 minutes, while experts reached it after 143 minutes.
• Highest achieved scores were 92% for novices and 96% for experts.
• The average plateau score was 85% for novices and 92% for experts.

Conclusions:

• Training time to reach a plateau in VR simulation varies significantly.
• Mastery-learning standards, rather than fixed training durations, are essential for effective surgical simulation.
• A performance score of 92%, comparable to expert plateau scores, is proposed as a mastery learning pass/fail standard.