Background Trainees are now facing reduced dedicated time in the operating theatre with expectation to reach the same level of competency and proficiency as their predecessors. We assessed whether a commercially available virtual reality dynamic hip screw (DHS) fixation (for an extracapsular fracture of the left neck of femur) simulation had a training effect to improve objective performance metrics.
Methodology 52 medical students were recruited and electronically randomised equally to two groups. Each participant was single-blinded prior to entering the study and tested in isolation to prevent inter- and intra-group learning. After watching an instructional video on completing the task, Group 1 (training) performed 5 attempts whilst Group 2 (control) performed only once. After one-week washout period, both cohorts repeated the same number of attempts. The median (and Bonett-Price 95% confidence interval) of first and last attempts were calculated from seven clinically pertinent real-time objective performance metrics that were recorded by the simulator. Mann-Whitney U-test and Wilcoxon signed-rank tests were used to calculate significance (p < 0.05).
Results All 52 subjects completed the study. Group 1 and Group 2 were significantly comparable at baseline apart from fluoroscopy time. The training group was 66% significantly quicker than control group (p < 0.001), used 70% less fluoroscopy (p < 0.001), took 67% number of radiographs (p < 0.001), had 83% retries guide wire insertions (p < 0.001), achieved a reduced tad by 37% (p < 0.001), lower probability cut-out 82% (p < 0.001) and scored increased global score 46% (p < 0.001).
Conclusions This is the first study to demonstrate a significant training effect on the virtual reality DHS simulator in improving objective performance metrics of naïve medical students. Effective training can reduce the burden of financial compensation, iatrogenic errors and adverse events in hospitals. Virtual reality simulation offers a viable resource to safely train while overcoming training limitations and maintaining patient safety as an utmost priority.
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- Category: Course or curriculum evaluation/innovation/integration
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