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Thesis
The effect of training on surgical resident skill acquisition
University of Iowa
Master of Science (MS), University of Iowa
Spring 2022
DOI: 10.17077/etd.006444
Abstract
Surgical simulation is widely presumed to help residents improve their operating skills, but this has seldom been demonstrated, and never demonstrated in orthopaedic trauma surgery. Collecting empirical evidence to support this relationship is difficult because surgical skill is not well defined and because trauma surgeries have many variable factors, such as injury severity, patient age, and other important factors, that can cloud the singular influence of the operating surgeon’s dexterity and skill. We hypothesized that skill could be measured through the frequency of certain behaviors characteristic of novices that are frequently exhibited during the wire navigation portion of pediatric supracondylar humerus fracture surgery, behaviors that simulator training would tend to reduce.
The frequency of the defined behaviors were measured in 35 fluoroscopic image sequences from pediatric supracondylar humerus fracture cases performed by 17 orthopaedic residents. Various additional metrics related to the surgery, such as the duration of the wire navigation procedure, the number of fluoroscopic images collected, and details related to the placement of the surgical wires, were also collected. A statistical analysis explored relationships between the behavior frequency, the surgical metrics, the previous experience of the surgeon, and whether the surgeon had received training with a simulator dedicated to this procedure. The wire navigation portion of the 35 cases had an average duration of 13.2 minutes, during which time an average of 53 fluoroscopic images were acquired. Residents performing the wire navigation had experience with an average of 19 similar cases, though this experience varied from one case to 49 cases. Seventeen of the residents had not received simulator training before participating in these surgeries. A regression model (p < 0.001) explained 39.36% of the variance in experience as a function of the number of fluoroscopic images (p = 0.002), whether the resident was trained (p = 0.004), and the relative placement of the center wire (p = 0.027). The behavior of overuse of fluoroscopic images significantly predicted the surgeons’ experience level. The model suggests that simulator training has a beneficial effect approximately equal to 12 cases in the resident’s ACGME case log.
Details
- Title: Subtitle
- The effect of training on surgical resident skill acquisition
- Creators
- Trevor Kurtzhals
- Contributors
- Geb W Thomas (Advisor)Donald D Anderson (Committee Member)Heather Kowalski (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Industrial Engineering
- Date degree season
- Spring 2022
- Publisher
- University of Iowa
- DOI
- 10.17077/etd.006444
- Number of pages
- vii, 42 pages
- Copyright
- Copyright 2022 Trevor Kurtzhals
- Language
- English
- Description illustrations
- Charts, graphs, tables
- Description bibliographic
- Includes bibliographical references (pages 36-42).
- Academic Unit
- Industrial and Systems Engineering
- Record Identifier
- 9984271254502771