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

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.