Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking

Medicina, vol. 58, pp. 773

Abstract

Background and Objectives: Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Materials and Methods: Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics—number of X-rays, nail hole roundness, drill tip position and drill hole accuracy—between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Results: Face validity: mean realism of the training device was rated 6.3 (range 4–7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5–7), with no significant differences between experts and novices, p ≥ 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 ± 6.4 versus 15.5 ± 5.3, p = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: n = 15; 55.6%; experts hit: n = 19; 83%, p = 0.040). Conclusion: The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks.

Authors 7

1. Torsten Pastor corresponding

   University of Bern · University Hospital of Bern · Luzerner Kantonsspital · AO Foundation

   Affiliation as printed

   AO Research Institute Davos, 7270 Davos, Switzerland

   Department of Hand Surgery, Bern University Hospital, University of Bern, 8008 Bern, Switzerland

   Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland

2. Philipp Kastner

   Johannes Kepler University of Linz · AO Foundation

   Affiliation as printed

   AO Research Institute Davos, 7270 Davos, Switzerland

   Department for Orthopaedics and Traumatology, Johannes Kepler University, 4021 Linz, Austria

3. Firas Souleiman

   University Hospital Leipzig · AO Foundation

   Affiliation as printed

   AO Research Institute Davos, 7270 Davos, Switzerland

   Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany

4. Matthias Knobe Aachen Medical Faculty

   RWTH Aachen University · Universitätsklinikum Aachen · University of Zurich · Luzerner Kantonsspital

   Affiliation as printed

   Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland

   Medical Faculty, RWTH Aachen University Hospital, 52074 Aachen, Germany

   Medical Faculty, University of Zurich, 8091 Zurich, Switzerland

5. Boyko Guergov Gueorguiev

   AO Foundation

   Affiliation as printed

   AO Research Institute Davos, 7270 Davos, Switzerland

6. Markus Windolf

   AO Foundation

   Affiliation as printed

   AO Research Institute Davos, 7270 Davos, Switzerland

7. Jan Buschbaum

   AO Foundation

   Affiliation as printed

   AO Research Institute Davos, 7270 Davos, Switzerland