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

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.
• 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.