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Mixed-Methods Analysis of a Validated Arthroscopic Knot-Tying Simulator With New Indirect Visualization Condition.

Kit Moran1, Carolyn Rotenberg1, Ahmed AlHussain1

  • 1Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Orthopaedic Journal of Sports Medicine
|August 9, 2021
PubMed
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Senior surgical trainees demonstrated superior arthroscopic knot-tying skills compared to junior trainees using the Arthroscopic Knot (ArK) Trainer. Experienced trainees utilized tactile cues more, suggesting direct visualization is key for beginners.

Area of Science:

  • Orthopaedic Surgery
  • Surgical Education
  • Medical Simulation

Background:

  • Simulation offers a safe environment for surgical trainees to develop fundamental skills.
  • The Arthroscopic Knot (ArK) Trainer is a validated tool for orthopaedic simulation.
  • Previous studies utilized direct visualization with clear plexiglass trainers.

Purpose of the Study:

  • To compare junior and senior trainees' arthroscopic knot-tying performance using the ArK Trainer.
  • To evaluate performance under both direct and indirect visualization conditions.
  • To characterize trainees' approaches to knot-tying through a mixed-methods approach.

Main Methods:

  • A cross-sectional study involving 14 orthopaedic surgery postgraduate trainees.
  • Trainees performed Seoul Medical Center (SMC) knots on the ArK Trainer under direct and indirect visualization.
Keywords:
arthroscopymedical educationorthopaedicssimulation trainingsports medicine

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  • Proficiency was assessed using a task-specific checklist (TSC), global rating scale (GRS), and proficiency scale (PS), supplemented by questionnaires and interviews.

    • Main Results:

    • Senior trainees outperformed junior trainees on both direct and indirect visualization setups.
    • Participants generally performed better under direct visualization.
    • Senior trainees were more likely to report using haptic cues, especially under direct visualization.

    Conclusions:

    • Senior trainees exhibit greater arthroscopic skill and outperform juniors on the ArK Trainer.
    • Tactile cue utilization correlates with knot-tying proficiency and experience.
    • Trainees recommended a progression from direct to indirect visualization for skill development.