Validity of A Novel Simulator for Percutaneous Transforaminal Endoscopic Discectomy.

BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) has steep learning curves and a high incidence of complications, but currently, efficient and economical training methods are lacking. This study aimed to validate a novel simulator for PTED. METHODS: The simulated PTED included puncturing and establishing the working channel (PEWC) and endoscopic discectomy, with the PEWC being the tested module. Eleven experts and 21 novices were included and introduced to the simulator and tasks; all participants completed the PEWC. Outcomes included: total operation time, number of fluoroscopy for positioning the working sheath, number of spinal risk region invasion, Global Rating Scale (GRS) and a modified GRS, etc. The Mann-Whitney U test was used to compare 2 groups. Spearman's correlation coefficient analyzed continuous variables. RESULTS: Experts outperformed novices in total operation time (P = 0.001), requiring fewer number of fluoroscopies for positioning the working sheath (P = 0.003). Additionally, experts had a lower number of spinal risk region invasions (P = 0.016) and higher scores on both the GRS (P < 0.001) and modified GRS (P < 0.001). PTED experience correlated with GRS scores (P = 0.001) and modified GRS (P < 0.001). The overall realism scored a median of 4 (3.75-5), and educational value had a median of 4 (range 3-5). CONCLUSIONS: This study demonstrates the validity of the novel simulator, revealing significant associations between PTED experience and performance metrics in a simulated PEWC setting. Furthermore, the PEWC module also offers a good realistic design and high education value according to experts.

A spaced retraining schedule with 2-day interval improves the acquisition and retention of simulation-based basic arthroscopic skills.

PURPOSE: To compare the effect of three differently spaced retraining schedules (1-day, 2-day, and 1-week intervals) on the acquisition of basic arthroscopic skills and skill retention after 3 months. METHODS: Thirty orthopaedic residents without arthroscopic experience were enrolled in a double-blind, randomised, parallel-controlled trial. Spaced retaining schedules were divided into massed training and retraining phases. Participants were required to obtain perfect scores in all tasks on the simulator in the massed training phase, followed by a pretest to evaluate the training effect. During the retraining phase, participants were randomly assigned to Groups A (1-day interval), B (2-day interval) or C (1-week interval). A posttest was used to evaluate the effect of different retraining patterns. Follow-up evaluations were conducted at 1 week, 1 month and 3 months after the completion of spaced retraining schedules to measure skill retention. One-way ANOVA and paired-sample t tests were used for statistical analysis. RESULTS: Significant between-group differences in diagnostic arthroscopy (137.0 ± 24.8 vs. 140.1 ± 21.3 vs. 175.3 ± 27.4 s, P(A-C) = 0.005, P(B-C) = 0.010) and loose body removal (193.1 ± 33.9 vs. 182.0 ± 32.1 vs. 228.7 ± 42.9 s, P(B-C) = 0.025) completion times were observed. No significant differences were found in other posttest metrics. An assessment of skill retention after the 3-month follow-up (Evaluation 3) showed significant differences in diagnostic arthroscopy completion time (202.5 ± 53.3 vs. 172.0 ± 27.2 vs. 225.5 ± 42.1 s, P(B-C) = 0.026). No significant differences were found in other Evaluation 3 metrics. CONCLUSION: The 2-day retraining schedule was the most effective for the acquisition and retention of basic arthroscopic skills and could be integrated into arthroscopic skills curricula. After a 3-month follow-up, residents who followed this schedule showed better skill retention than those who followed the 1-week interval schedule. LEVEL OF EVIDENCE: Level I.