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Expert Performance on a Hip Wire Navigation Simulator Provides a Basis for Establishing Benchmarks to Define Skill

Steven Long1, Geb W Thomas1,2, Donald D Anderson1,2,3

  • 1Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA, USA.

Clinical Orthopaedics and Related Research
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Simulator training effectively differentiates orthopedic surgical skill levels. An Image-based Decision Error Analysis (IDEA) score of 0.5 is proposed as a benchmark for safe operating room readiness.

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Area of Science:

  • Orthopedic surgery simulation
  • Surgical skill acquisition
  • Medical training benchmarks

Background:

  • Simulator-based training offers a safer alternative to traditional operating room learning for surgical skills.
  • The Core Requisites of Orthopedic Wire Navigation Skills (CROWNS) curriculum uses hybrid reality simulators for guidewire placement training.
  • Objective benchmarks are needed to assess proficiency in simulator-based surgical training.

Purpose of the Study:

  • To measure and compare expert and novice performance on a simulated hip wire navigation task.
  • To establish candidate proficiency training benchmarks using objective performance metrics.

Main Methods:

  • 113 surgeons (68 residents, 45 experts) performed a simulated hip wire navigation task.
  • Participants completed scenarios with varying complexity, replicating intertrochanteric fracture fixation.
  • Performance was assessed using Tip-Apex Distance (TAD), fluoroscopic image count, time, decision errors, and the Image-based Decision Error Analysis (IDEA) score.

Main Results:

  • Experts demonstrated significantly higher IDEA scores (0.65 ± 0.4) compared to novices (-0.21 ± 0.7) in the shared scenario (p < 0.001).
  • Expert performance was comparable to novices after approximately 11 surgical cases.
  • A proposed benchmark IDEA score of 0.5 was achieved by 75% of experts but only 13% of novices.

Conclusions:

  • The CROWNS simulator and IDEA score effectively distinguish between expert and novice surgical skills.
  • A benchmark IDEA score of 0.5 represents a rigorous yet attainable goal for resident proficiency.
  • Simulation-based proficiency standards can guide competency-based progression for safe operating room performance.