Exploring the generalizability of wire navigation skills attained through simulator training

Wire navigation is a common skill used in a variety of core orthopaedic procedures. Our team previously developed a simulator to train residents on this skill and have shown that skills developed on the simulator transfer to the operating room for a given procedural task. However, it has not yet been determined if skill attained through simulator training on one procedural task generalizes to others. To explore this question, we tested if training on a femoral neck fracture simulation improves performance in placing a center-center wire for an intertrochanteric fracture.

This study was conducted at 2 2019 OTA/AO Comprehensive Fracture Courses for Residents. A total of 160 residents (80 working pairs) participated. Residents first performed a baseline assessment, placing a guide wire in the center-center position, aiming to minimize tip-apex distance, fluoroscopy use, total time, and decision-making errors. The simulator then provided training on wire placement for pinning femoral neck fractures using a three-wire configuration. Residents then repeated the center-center wire placement assessment on a different simulated intertrochanteric fracture case. The results were evaluated using a composite score that incorporates the tip-apex distance, decision-making errors, and the magnitude of these errors.

A total of 129 residents completed the full protocol in the allotted time. Residents improved significantly between baseline and post-training assessments on all performance measures (paired T-test, P < 0.05). Among residents with a baseline score less than zero (i.e., below acceptable performance levels), 91% improved their score with an average improvement of 0.9.

This study demonstrates that training on a 3-wire configuration for pinning femoral neck fractures helps residents improve their skills in placing a center-center guide wire. The ability to generalize wire navigation skills led to fewer decision errors, reduced tip-apex distance, less fluoroscopy use, and better overall performance. Notably, residents who needed the training the most showed the greatest improvement.

Residents and programs do not have the time or financial capacity to train on every single procedure in the orthopaedic spectrum. Better understanding how skills generalize between procedures will help focus training efforts and resources while still achieving the goal of producing technically skilled orthopaedic surgeons.