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0193 Distributive Interactive Simulation (dis) For Intramedullary Femoral Nailing: A Feasability Study
  1. Kapil Sugand,
  2. Kash Akhtar,
  3. Amarjit Anand,
  4. Akash Patel,
  5. Rajarshi Bhattacharya,
  6. Chinmay Gupte
  1. MSk Lab, Imperial College, London, UK


Background The worldwide incidence of trauma is increasing and the World Health Organisation has identified it as a major cause of clinical burden globally. Intramedullary nailing is a common orthopaedic procedure and is one of the definitive surgical treatments for open fractures of the lower limb. We piloted the first intraoperative intramedullary nailing scenario and to create a global rating scale for its assessment.

Methodology 9 participants from different stages of orthopaedic training were recruited and attended a lecture showing all the steps required to perform the procedure. The scenario consisted of an Orthopaedic trainee being called into theatre to complete a trochanteric intramedullary nail with the help of a scrub nurse, runner and anaesthetist. Metrics were assessed for each participant by two senior orthopaedic trainees using a novel 16-point global rating score (range 1–5) for which the Cronbach alpha for inter-rater validity was calculated. Each participant was also individually debriefed after the exercise with their assessor for reflection and constructive feedback.

Results 66% of participants were male (n = 6). The median level of training was post-graduate year 4 (range PG yrs 2–7), with experience of observing 10 cases, assisting in 10 cases and none had performed cases independently. Pre-and post-questionnaire results were both significant within the cohort (p = 0.013 and p < 0.0001 respectively). All questions had a positive change in perception. Cronbach alpha was 0.89 of the global rating score with a median score of 62 (77.5%) out of 80.

Conclusions This is the first pilot study to validate an entire simulated intramedullary trochanteric nail under pressure within a multi-disciplinary team environment using a mobile theatre set up. The simulation scenario was found to have significant acceptability and a realistic global rating scale. This simulation scenario can also be reproducible anywhere since it is an out-of-box mobile operating theatre unit.


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  • Category: Course or curriculum evaluation/innovation/integration

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