Acta Ortopédica Mexicana

Arroyo-Berezowsky C
Development for an arthroscopy simulation program for orthopedic residents
Acta Ortop Mex 2018; 32 (5)

Language: Español
References: 28
Page: 297-302
PDF: 121.05 Kb.

[Fulltext - PDF]


Background: There are less and fewer opportunities for residents to learn and develop surgical skills in the operating room. In some parts of the world, the development and adaptation of technology for the teaching of psychomotor skills in surgical specialties appears. Arthroscopy is a surgical technique that lends itself to simulation. So far there is no such thing as a structured and validated arthroscopy training program for orthopaedic residents in Mexico. Objective: To propose a structured arthroscopy training plan that incorporates the simulation for orthopaedic residents. Method: A review of the literature on teaching with simulation in orthopaedics and arthroscopy was performed, a study was conducted to establish reference values for arthroscopy exercises in a virtual reality simulator and a training plan was developed with Arthroscopy simulation for orthopaedic residents. Results: A seven-stage program was developed with theoretical classes and simulation to improve motor skills. The complexity of the procedures increases through the practical modules. It is complemented by a semester evaluation. Discussion: Currently most of the efforts in teaching with simulators focus on medical students and first-and second-year residents. I believe that efforts should be focused to include residents of higher ranks and surgeons. This design will be proposed to the orthopaedic Unique Medical Education Program (PUEM in Spanish). It is important to develop validated curricula that incorporate the simulation for the development of motor skills in orthopaedic residents.

Key words: Simulation, arthroscopy, resident, education, virtual reality.


  1. Dougherty PJ. CORR curriculum - orthopaedic education: Faculty development begins at home. Clin Orthop Relat Res. 2014; 472(12): 3637-43.

  2. Rosen KR. The history of medical simulation. J Crit Care. 2008; 23(2): 157-66.

  3. Hui Y, Safir O, Dubrowski A, Carnahan H. What skills should simulation training in arthroscopy teach residents? A focus on resident input. Int J Comput Assist Radiol Surg. 2013; 8(6): 945-53.

  4. Akhtar K, Sugand K, Wijendra A, Standfield NJ, Cobb JP, Gupte CM. Training safer surgeons: How do patients view the role of simulation in orthopaedic training? Patient Saf Surg. 2015; 9: 11.

  5. Kalraiya A, Buddhdev P. The TROJAN Project: creating a customized international orthopedic training program for junior doctors. Orthop Rev (Pavia). 2015; 7(1): 5750.

  6. Pitts D, Rowley DI, Sher JL. Assessment of performance in orthopaedic training. J Bone Joint Surg Br. 2005; 87(9): 1187-91.

  7. Coughlin RP, Pauyo T, Sutton JC 3rd, Coughlin LP, Bergeron SG. A validated orthopaedic surgical simulation model for training and evaluation of basic arthroscopic skills. J Bone Joint Surg Am. 2015; 97(17): 1465-71.

  8. Bergfeld JA. Issues with accreditation and certification of orthopaedic surgery fellowships. J Bone Joint Surg Am. 1998; 80(12): 1833-6; discussion 1846-50.

  9. Leonard M, Kennedy J, Kiely P, Murphy PG. Knee arthroscopy: how much training is necessary? A cross-sectional study. Eur J Orthop Surg Traumatol. 2007; 17(4): 359-62.

  10. Van den Dobbelsteen JJ, Karahan M, Akgün U. Theory on psychomotor learning applied to arthroscopy. In: Karahan M, Kerkhoffs MMJG, Randelli P, Tuijthof JMG, editors. Effective training of arthroscopic skills. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015. p. 17-32.

  11. Hodgins JL, Veillette C. Arthroscopic proficiency: methods in evaluating competency. BMC Med Educ. 2013; 13: 61.

  12. Stirling ER, Lewis TL, Ferran NA. Surgical skills simulation in trauma and orthopaedic training. J Orthop Surg Res. 2014; 9: 126.

  13. Unalan PC, Akan K, Orhun H, Akgun U, Poyanli O, Baykan A, et al. A basic arthroscopy course based on motor skill training. Knee Surg Sports Traumatol Arthrosc. 2010; 18(10): 1395-9.

  14. Gardner AK, Scott DJ, Pedowitz RA, Sweet RM, Feins RH, Deutsch ES, et al. Best practices across surgical specialties relating to simulation-based training. Surgery. 2015; 158(5): 1395-402.

  15. Martin KD, Patterson DP, Cameron KL. Arthroscopic training courses improve trainee arthroscopy skills: a simulation-based prospective trial. Arthroscopy. 2016; 32(11): 2228-32.

  16. Lubowitz JH, Provencher MT, Brand JC, Rossi MJ. Learning the language of Copernicus. Arthroscopy. 2015; 31(8): 1423-5.

  17. Niitsu H, Hirabayashi N, Yoshimitsu M, Mimura T, Taomoto J, Sugiyama Y, et al. Using the objective structured assessment of technical skills (OSATS) global rating scale to evaluate the skills of surgical trainees in the operating room. Surg Today. 2013; 43(3): 271-5.

  18. Hetaimish B, Elbadawi H, Ayeni OR. Evaluating simulation in training for arthroscopic knee surgery: a systematic review of the literature. Arthroscopy. 2016; 32(6): 1207-20.e1.

  19. Garfjeld-Roberts P, Guyver P, Baldwin M, Akhtar K, Alvand A, Price AJ, et al. Validation of the updated ArthroS simulator: face and construct validity of a passive haptic virtual reality simulator with novel performance metrics. Knee Surg Sports Traumatol Arthrosc. 2017; 25(2): 616-25.

  20. Slade-Shantz JA, Leiter JR, Gottschalk T, MacDonald PB. The internal validity of arthroscopic simulators and their effectiveness in arthroscopic education. Knee Surg Sports Traumatol Arthrosc. 2014; 22(1): 33-40.

  21. Howells NR, Gill HS, Carr AJ, Price AJ, Rees JL. Transferring simulated arthroscopic skills to the operating theatre: a randomised blinded study. J Bone Joint Surg Br. 2008; 90(4): 494-9.

  22. Boutefnouchet T, Laios T. Transfer of arthroscopic skills from computer simulation training to the operating theatre: a review of evidence from two randomised controlled studies. SICOT J. 2016; 2: 4.

  23. Middleton RM, Baldwin MJ, Akhtar K, Alvand A, Rees JL. Which Global Rating Scale? A Comparison of the ASSET, BAKSSS, and IGARS for the Assessment of Simulated Arthroscopic Skills. J Bone Joint Surg Am. 2016; 98(1): 75-81.

  24. Koehler RJ, Amsdell S, Arendt EA, Bisson LJ, Braman JP, Butler A, et al. The arthroscopic surgical skill evaluation tool (ASSET). Am J Sports Med. 2013; 41(6): 1229-37.

  25. Hiemstra E, Kolkman W, Wolterbeek R, Trimbos B, Jansen FW. Value of an objective assessment tool in the operating room. Can J Surg. 2011; 54(2): 116-22.

  26. Koehler RJ, Goldblatt JP, Maloney MD, Voloshin I, Nicandri GT. Assessing diagnostic arthroscopy performance in the operating room using the arthroscopic surgery skill evaluation tool (ASSET). Arthroscopy. 2015; 31(12): 2314-9.e2.

  27. Bayona S, Akhtar K, Gupte C, Emery RJ, Dodds AL, Bello F. Assessing performance in shoulder arthroscopy: the imperial global arthroscopy rating scale (IGARS). J Bone Joint Surg Am. 2014; 96(13): e112.

  28. Sridhar AN, Briggs TP, Kelly JD, Nathan S. Training in robotic surgery-an overview. Curr Urol Rep. 2017; 18(8): 58.