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首页> 外文期刊>Acta orthopaedica. >Hip-fracture osteosynthesis training: exploring learning curves and setting proficiency standards
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Hip-fracture osteosynthesis training: exploring learning curves and setting proficiency standards

机译：髋部骨折接骨术培训：探索学习曲线并设定熟练水平

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Background and purpose — Orthopedic surgeons must be able to perform internal fixation of proximal femoral fractures early in their career, but inexperienced trainees prolong surgery and cause increased reoperation rates. Simulation-based virtual reality (VR) training has been proposed to overcome the initial steep part of the learning curve but it is unknown how much simulation training is necessary before trainees can progress to supervised surgery on patients. We determined characteristics of learning curves for novices and experts and a pass/fail mastery-learning standard for junior trainees was established.Methods — 38 first-year residents and 8 consultants specialized in orthopedic trauma surgery performed cannulated screws, Hansson pins, and sliding hip screw on the Swemac TraumaVision VR simulator. A previously validated test was used. The participants repeated the procedures until they reached their learning plateau.Results — The novices and the experts reached their learning plateau after an average of 169?minutes (95% CI 152–87) and 143?minutes (CI 109–177), respectively. Highest achieved scores were 92% (CI 91–93) for novices and 96% (CI 94–97) for experts. Plateau score, defined as the average of the 4 last scores, was 85% (CI 82–87) and 92% (CI 89–96) for the novices and the experts, respectively.Interpretation — Training time to reach plateau varied widely and it is paramount that simulation-based training continues to a predefined standard instead of ending after a fixed number of attempts or amount of time. A score of 92% comparable to the experts’ plateau score could be used as a mastery learning pass/fail standard.
机译：背景与目的—骨科医生必须在职业生涯的早期阶段就能够对股骨近端骨折进行内固定，但是经验不足的受训者会延长手术时间并导致再次手术的发生率增加。已经提出了基于模拟的虚拟现实（VR）训练来克服学习曲线的初始陡峭部分，但未知在受训者可以进行患者的有监督手术之前需要多少模拟训练。我们确定了新手和专家的学习曲线特征，并为初级学员建立了通过/失败的精通学习标准。方法-38名一年级住院医师和8名骨科创伤手术专业顾问进行了空心螺钉，Hansson销钉和髋关节滑动拧上Swemac TraumaVision VR模拟器。使用先前验证的测试。结果–新手和专家分别在平均169分钟（95％CI 152–87）和143分钟（CI 109–177）之后达到他们的学习平台。 。新手的最高得分为92％（CI 91-93），专家的最高得分为96％（CI 94-97）。高原评分（定义为最后4个评分的平均值）对于新手和专家分别为85％（CI 82–87）和92％（CI 89–96）。解释—达到高原的培训时间差异很大，至关重要的是，基于模拟的训练将继续遵循预定义的标准，而不是在经过固定的尝试次数或时间量之后结束。与专家的稳定期分数相当的92％分数可以用作精通学习合格/不合格的标准。

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