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1.
J Hand Surg Am ; 2022 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-35843761

RESUMEN

PURPOSE: We developed 2 complementary low-fidelity models to be used to create the tool skills needed to perform small joint arthroscopy. The purpose of the study was to establish the face and construct validity of the 2 models. METHODS: The "foundation model" was constructed from lemon and radish sections, and the "advanced model" was constructed from a chicken knee. Using both models, novice, intermediate, and experienced participants were asked to perform specific tasks and were timed and scored on their performance. The experienced surgeons were given a 16-item survey to rate how closely each model emulated reality to determine face validity. RESULTS: For the foundation model, the mean total time for the completion of tasks was 1,138 seconds for novices, 1,059 seconds for intermediates, and 631 seconds for experienced, with significant differences between the groups for time to complete 2 of the tasks. With a maximum possible score of 50 points for the correct performance of all tasks, the mean total performance score was 23 for novices, 31.8 for intermediates, and 42.2 for experienced operators. For the advanced model, the mean total time for completion was 266 seconds for novices, 147 seconds for intermediates, and 72 seconds for experienced participants. With a maximum possible score of 31 points for the correct performance of all tasks, the mean total performance score was 1.9 for novices, 15.0 for intermediates, and 24.3 for experienced participants. The average scores for the face validity surveys using a 5-point Likert scale were 4.2 and 4.5 of 5 possible points for the foundation and advanced models, respectively. CONCLUSIONS: Experienced operators completed the tasks more quickly and had higher performance scores than the operators in other groups. This correlation between experience and performance suggests that both models have construct validity. The face validity scores were on the upper end of the scale, suggesting that both models emulate reality for experienced operators. CLINICAL RELEVANCE: These novel models provide low-cost, available and valid simulations conducive to high-repetition training.

2.
J Am Acad Orthop Surg ; 28(19): e865-e871, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-32453010

RESUMEN

Our orthopaedic surgery department at Montefiore Medical Center and Albert Einstein College of Medicine is located within the Bronx, a borough of New York City, and serves a densely populated urban community. Since the beginning of the novel coronavirus outbreak in New York City, the medical center was forced to rapidly adapt to the projected influx of critically ill patients. The aim of this report is to outline how our large academic orthopaedic surgery department adopted changes and alternative practices in response to the most daunting challenge to public health in our region in over a century. We hope that this report provides insight for others facing similar challenges.


Asunto(s)
Centros Médicos Académicos/organización & administración , Infecciones por Coronavirus/terapia , Departamentos de Hospitales/organización & administración , Hospitales de Alto Volumen , Manejo de Atención al Paciente/métodos , Neumonía Viral/terapia , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Ciudad de Nueva York/epidemiología , Ortopedia , Pandemias , Neumonía Viral/epidemiología , SARS-CoV-2
3.
J Am Acad Orthop Surg ; 28(4): e172-e180, 2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-31206440

RESUMEN

INTRODUCTION: This study establishes the construct validity of a low-cost training platform designed for high-repetition training of the skills required for fluent use of the five specific tools described for free-hand pedicle screw placement and breach avoidance. METHODS: A total of 19 participants were included and divided into three groups based on spine surgery experience. Participants were asked to place five pedicle screws into the model. The performance was assessed by recording breaches, technical criteria (0 to 44 points), time to completion, and angulation of the screws. Success (no breaches, no protrusions) frequency (success/time) was calculated and analyzed. RESULTS: Participants included three spine surgeons, seven advanced trainees (who had placed >10 pedicle screws), and nine inexperienced trainees. None of the screws placed by the spine surgeons breached the pedicle wall. Eight of 35 screws placed by advanced trainees (22.9%) and 31 of 45 screws placed by inexperienced trainees (68.9%) had a pedicle breach. Spine surgeons had a higher median success frequency compared with inexperienced trainees and advanced trainees (P = 0.015). The time needed to place a screw decreased over time (P < 0.0001). There was a trend toward an association between increased training level and decreased time to place five screws (P = 0.076). Increased training level was associated with greater total points scored (P < 0.0001). More screws placed by inexperienced trainees were further away from the ideal pedicle axis compared with those placed by advanced trainees or spine surgeons. CONCLUSION: An association exists between training level and performance on the pedicle screw model, which suggests construct validity when evaluating our model's use for teaching surgeon learners. The model is easily assembled and is an alternative spine surgery training tool that overcomes limited availability and considerable costs of other training platforms. It can be used in high repetition to establish tool-skill fluency. LEVEL OF EVIDENCE: Level I.


Asunto(s)
Competencia Clínica , Educación de Postgrado en Medicina , Educación/métodos , Cirujanos Ortopédicos/educación , Tornillos Pediculares , Fusión Vertebral/métodos , Humanos
4.
Arthroscopy ; 33(8): 1567-1572, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28502388

RESUMEN

PURPOSE: To establish the construct validity of an arthroscopic training model that teaches arthroscopic tool skills including triangulation, grasping, precision biting, implant delivery and ambidexterity and uses a whole grapefruit for its training platform. METHODS: For the grapefruit training model (GTM), an arthroscope and arthroscopic instruments were introduced through portals cut in the grapefruit skin of a whole prepared grapefruit. After institutional review board approval, participants performed a set of tasks inside the grapefruit. Performance for each component was assessed by recording errors, achievement of criteria, and time to completion. A total of 19 medical students, orthopaedic surgery residents, and fellowship-trained orthopaedic surgeons were included in the analysis and were divided into 3 groups based on arthroscopic experience. One-way analysis of variance (ANOVA) and the post hoc Tukey test were used for statistical analysis. RESULTS: One-way ANOVA showed significant differences in both time to completion and errors between groups, F(2, 16) = 16.10, P < .001; F(2, 16) = 17.43, P < .001. Group A had a longer time to completion and more errors than group B (P = .025, P = .019), and group B had a longer time to completion and more errors than group C (P = .023, P = .018). CONCLUSIONS: The GTM is an easily assembled and an alternative arthroscopic training model that bridges the gap between box trainers, cadavers, and virtual reality simulators. Our findings suggest construct validity when evaluating its use for teaching the basic arthroscopic tool skills. As such, it is a useful addition to the arthroscopic training toolbox. CLINICAL RELEVANCE: There is a need for validated low-cost arthroscopic training models that are easily accessible.


Asunto(s)
Artroscopía/educación , Competencia Clínica , Modelos Anatómicos , Citrus paradisi , Humanos , Ortopedia/educación , Reproducibilidad de los Resultados , Análisis y Desempeño de Tareas
5.
Clin Orthop Relat Res ; 474(4): 945-55, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26369658

RESUMEN

BACKGROUND: A surgical procedure is a complex behavior that can be constructed from foundation or component behaviors. Both the component and the composite behaviors built from them are much more likely to recur if it they are reinforced (operant learning). Behaviors in humans have been successfully reinforced using the acoustic stimulus from a mechanical clicker, where the clicker serves as a conditioned reinforcer that communicates in a way that is language- and judgment-free; however, to our knowledge, the use of operant-learning principles has not been formally evaluated for acquisition of surgical skills. QUESTIONS/PURPOSES: Two surgical tasks were taught and compared using two teaching strategies: (1) an operant learning methodology using a conditioned, acoustic reinforcer (a clicker) for positive reinforcement; and (2) a more classical approach using demonstration alone. Our goal was to determine whether a group that is taught a surgical skill using an operant learning procedure would more precisely perform that skill than a group that is taught by demonstration alone. METHODS: Two specific behaviors, "tying the locking, sliding knot" and "making a low-angle drill hole," were taught to the 2014 Postgraduate Year (PGY)-1 class and first- and second-year medical students, using an operant learning procedure incorporating precise scripts along with acoustic feedback. The control groups, composed of PGY-1 and -2 nonorthopaedic surgical residents and first- and second-year medical students, were taught using demonstration alone. The precision and speed of each behavior was recorded for each individual by a single experienced surgeon, skilled in operant learning. The groups were then compared. RESULTS: The operant learning group achieved better precision tying the locking, sliding knot than did the control group. Twelve of the 12 test group learners tied the knot and precisely performed all six component steps, whereas only four of the 12 control group learners tied the knot and correctly performed all six component steps (the test group median was 10 [range, 10-10], the control group median was 0 [range, 0-10], p = 0.004). However, the median "time to tie the first knot" for the test group was longer than for the control group (test group median 271 seconds [range, 184-626 seconds], control group median 163 seconds [range 93-900 seconds], p = 0.017), whereas the "time to tie 10 of the locking, sliding knots" was the same for both groups (test group mean 95 seconds ± SD = 15 [range, 67-120 seconds], control group mean 95 seconds ± SD = 28 [range, 62-139 seconds], p = 0.996). For the low-angle drill hole test, the test group more consistently achieved the ideal six-step behavior for precisely drilling the low-angle hole compared with the control group (p = 0.006 for the median number of technique success comparison with an odds ratio [at the 95% confidence interval] of 82.3 [29.1-232.8]). The mean time to drill 10 low-angle holes was not different between the test group (mean 193 seconds ± SD = 26 [range, 153-222 seconds]) and the control group (mean 146 seconds ± SD = 63 [range, 114-294 seconds]) (p = 0.084). CONCLUSIONS: Operant learning occurs as the behavior is constructed and is highly reinforced with the result measured, not in the time saved, but in the ultimate outcome of an accurately built complex behavior. LEVEL OF EVIDENCE: Level II, therapeutic study.


Asunto(s)
Condicionamiento Operante , Educación de Postgrado en Medicina/métodos , Educación de Pregrado en Medicina/métodos , Internado y Residencia , Procedimientos Ortopédicos/educación , Estudiantes de Medicina/psicología , Enseñanza/métodos , Estimulación Acústica , Competencia Clínica , Curriculum , Femenino , Humanos , Masculino , Desempeño Psicomotor , Refuerzo en Psicología , Análisis y Desempeño de Tareas , Factores de Tiempo
6.
Orthop J Sports Med ; 2(4): 2325967114530075, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26535320

RESUMEN

BACKGROUND: Surgical reconstruction of the anterior cruciate ligament (ACL) can be complicated by incorrect and variable tunnel placement, graft tunnel mismatch, cortical breaches, and inadequate fixation due to screw divergence. This is the first report describing the use of a C-arm with image intensifier employed for the sole purpose of eliminating those complications during transtibial ACL reconstruction. PURPOSE: To determine if the use of a C-arm with image intensifier during arthroscopically assisted transtibial ACL reconstruction (IIAA-TACLR) eliminated common complications associated with bone-patellar tendon-bone ACL reconstruction, including screw divergence, cortical breaches, graft-tunnel mismatch, and improper positioning of the femoral and tibial tunnels. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 110 consecutive patients (112 reconstructed knees) underwent identical IIAA-TACLR using a bone-patellar tendon-bone autograft performed by a single surgeon. Intra- and postoperative radiographic images and operative reports were evaluated for each patient looking for evidence of cortical breeching and screw divergence. Precision of femoral tunnel placement was evaluated using a sector map modified from Bernard et al. Graft recession distance and tibial α angles were recorded. RESULTS: There were no femoral or tibial cortical breaches noted intraoperatively or on postoperative images. There were no instances of loss of fixation screw major thread engagement. There were no instances of graft-tunnel mismatch. The positions of the femoral tunnels were accurate and precise, falling into the desired sector of our location map (sector 1). Tibial α angles and graft recession distances varied widely. CONCLUSION: The use of the C-arm with image intensifier enabled accurate and precise tunnel placement and completely eliminated cortical breach, graft-tunnel mismatch, and screw divergence during IIAA-TACLR by allowing incremental adjustment of the tibial tunnel and knee flexion angle. Incremental adjustment was essential to accomplish this. Importantly, a C-arm with image intensifier can be used with any ACL reconstruction that incorporates tunnels in the technique, with the expectation of increase in accuracy and precision and the elimination of common complications. CLINICAL RELEVANCE: The use of an image intensifier during transtibial ACL reconstruction will substantially reduce the common complications associated with the procedure and improve both accuracy and precision of tibial and femoral tunnel placement. Use of an image intensifier unit is generalizable to an individual surgeon's preferences for graft choices and drilling techniques and will be especially valuable when the intercondylar architecture is altered from injury, time, or prior surgery.

7.
Arthroscopy ; 19(3): 314-7, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12627158

RESUMEN

Femoral interference screw divergence can potentially have detrimental consequences in the rehabilitation of anterior cruciate ligament (ACL) reconstruction. Several biomechanical studies suggest that divergence angles greater than 15 degrees significantly decrease the pullout strength of the graft. Numerous techniques have been described in the literature that address this issue; however, the use of an image intensifier intraoperatively is not frequently discussed. We describe a technique in which fluoroscopy is used to confirm the proper position of the femoral interference screw at the time of the procedure, and therefore minimizes the incidence of significant screw divergence. Radiographic analysis of 62 patients who underwent endoscopic ACL reconstruction using bone-patellar tendon-bone autograft using this technique revealed significant divergence in only 3% of patients.


Asunto(s)
Ligamento Cruzado Anterior/cirugía , Tornillos Óseos , Fémur/diagnóstico por imagen , Fluoroscopía , Cuidados Intraoperatorios , Radiografía Intervencional , Lesiones del Ligamento Cruzado Anterior , Antropometría , Artroscopía , Fenómenos Biomecánicos , Trasplante Óseo , Falla de Equipo , Fémur/cirugía , Humanos , Traumatismos de la Rodilla/rehabilitación , Osteotomía , Complicaciones Posoperatorias/prevención & control , Rango del Movimiento Articular , Tendones/trasplante
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