Basic knee arthroscopy is an essential surgical skill and should be an integral part of Orthopaedic training. However, achieving and testing proficiency presents a challenge, particularly in Southern Africa academic hospitals where there is diluted exposure to elective cases due to high trauma burden.
A prospective observational cohort study was conducted to assess the knee arthroscopic skill of Orthopaedic trainees using ViraMed ArthroS virtual simulation. Trainees were assessed on a basic diagnostic knee arthroscopy using virtual simulation. Surgical proficiency was reported using virtual simulated composite scores derived from procedure time, safety and economy. Following a practice attempt the final score was recorded. Post assessment questionnaires evaluated face validity (realism), user friendliness and educational value.
25 Trainees in a large South African academic hospital were included (20 male, median age 33.5 years). This included pre-registrar Medical Officers (13), Registrars in the postgraduate program(12). In the practice attempt trainees scored a median of 28 (23-37). The final score was a median of 42 (41-47) which is an statistically significant increase of 48%. The trainees scored highest in safety and weakest in economy. There was a no statistical difference in the median composite score between Medical Officers and Registrars. Trainees confirmed good face validity for the outer and intra-articular joint appearance with median score 10 (8-10) and 8 (8-9) respectively. User friendliness was rated high at 9 (8-10). 93 percent of trainees agreed that the simulator had educational value.
We conclude that assessment and training experience of knee arthroscopy with virtual simulation can be achieved. The ViraMed ArthoS had high perceived face validity and educational value. Repeated utilization contributed to enhanced scores which supports its usefulness as tool for training in our cohort. Level of training did not correlate to increased scores which may highlight inadequacies in exposure or skill transfer in our training. Additional research is necessary to evaluate the effectiveness of Virtual simulation in work-based assessments and establish a definitive passing or failing score threshold.