Surgical Simulator Under Utilization: Why?

When orthopedic surgeons at the University of Iowa saw that the department’s arthroscopic simulators were gathering a bit of dust, they saw a research opportunity. Their work, “Failure of Orthopaedic Residents to Voluntarily Participate in a Laboratory Skills Training,” appears in the February 15, 2022, edition of the Journal of the American Academy of Orthopaedic Surgeons.

Co-author Matthew D. Karam, M.D. vice chair of education and orthopedic surgery residency director at the University of Iowa Hospitals and Clinics explained what happened to OTW.

“Simulation training in orthopedics is an exciting educational opportunity that has been increasing in profile [in] many residency programs including our own. However, this training tool, like any, requires deliberate and consistent use to recognize is desired benefits. We felt this created an opportunity to investigate simulation use. Anecdotally we noticed our arthroscopy simulators daily use by residents was lacking.”

After collecting 58 months’ worth of simulator use data, the researchers compared the numbers to those of two other residency programs. The team found that the average annual simulator use at their institution was 27.7 hours; orthopedic residents averaged 1.7 hours on the simulation trainer during the study.

“While the annual use of the arthroscopic simulator in our department was clearly low,” Dr. Karam told OTW, “I think that the most important results from this research are found at the level of the individual residents. We found that only 21% of residents are using the simulator at a level required for skills improvement. However, 86% of residents agreed that the simulator should become a mandated component of resident training.”

“This tells us that while the use of simulation tools is popular among the residents, they are still not using these tools to their full potential. Pinpointing these disparities between interest and actual use provides a great starting point in improving our simulation-based curricula, and we see a mandating simulation-based curriculum as the first step in that process.”

“One of my biggest takeaways of this paper is that simulators offer great educational potential if they are implemented properly into the residency training curricula. The implementation of such curricula is the key in maximizing the full potential of simulation tools. Future residents will have or need dedicated time in which they can practice their surgical skills on a simulator, and then review their performances prior to participating in the actual OR.”

“The ability to review overall simulation time of our VirtaMed simulator provided us with a direct metric that confirmed our suspicions of low overall use under a voluntary simulation-based curriculum. These findings supported the idea that simply purchasing simulators and expecting resident use is not the best approach. As Iowa and many other orthopedic residency programs expand their simulation offerings, it is essential that we monitor the use of these tools and tailor our curricula to maximize efficacy.”