Orthopaedic residency training is in the midst of a paradigm shift. Recent mandates from the Residency Review Committee (RRC) for Orthopaedic Surgery and the American Board of Orthopaedic Surgery (ABOS) are requiring that programs must provide structured motor skills training to first year residents. Although other surgical fields such as laparoscopic surgery have been using simulation tools to train incoming residents for over a decade, the orthopaedic field has lagged behind in developing these training tools. Given the need for orthopaedic training devices and the lack of currently available solutions to residency programs, this work has focused on developing a surgical simulator for the task of hip guide wire navigation. Hip wire navigation was targeted for this work because it is a core competency skill for surgical residents and few options currently exist for training residents on this task.
Much of this work focuses on the development of the wire navigation simulator. The simulator has six main components; a single camera interfaced with a Raspberry Pi (a credit-card sized computer), a series of three mirrors, a surrogate femur, a guide wire driver, a laser etched guide wire, and a laptop. These components interact to create virtual radiograph images that the resident can use to place the guide wire inside the bone. The goal in developing this simulator is to provide a platform which enables residents to acquire the skill of hip wire navigation in a safe environment and eventually transfer that skill into the operating room.
Assessment of the simulator has shown that the guide wire can be located in bone within 1.5mm of its true position and less than a degree of its true trajectory. This level of accuracy is sufficient for providing residents with a training tool to practice their technique on.
In training with resident surgeons, initial trends show that practicing with the simulator can result in an improvement in one’s technique. Residents who have trained with the simulator show a decrease in both the amount of radiographic images required to complete the procedure and the amount of time required to perform the procedure in a pseudo operating room environment. While more work is needed to be done to show the significance of this trend, this work has achieved its goal of providing residents with a safe platform for practicing the task of hip guide wire navigation.