Contextualization of Simulation-based Training for Basic Arthroscopic Skills

Background: Arthroscopy is a type of orthopaedic minimally invasive surgery very commonly performed but difficult to teach and learn. Objective: The purpose of this project was to explore the differences in learning to perform simulated basic arthroscopic skills relative to different contexts: scenarios, simulator features. We hypothesized that using a contextualized approach, with scenarios and knee arthroscopy simulator features, would result in better performance by novices. Methods: After conducting two preliminary studies defining generic basic arthroscopic skills, we conducted the present project as a prospective, randomized, two-arm pilot study with de-contextualized and contextualized arms. The study design included a pre-test/post-test during one session, and a retention test one month later. A checklist and a global rating scale were used to assess performance and a survey was used to elicit participants’ perceptions about the training sessions and simulator. Results: On the post-test, all participants demonstrated improvement in their basic arthroscopic skills. Participants in the contextualized group maintained their skills at the post- and retention tests as well as participants in the de-contextualized group. Their improvement on the post- and retention tests, compared to decontextualized group, was not as good. On the survey, 90% of participants evaluated the experience, during both testing sessions, as very good/excellent. Only 25% of participants were aware that the context provided during the practice time impacted their performance on the post-test. Discussion: Our study results did not support our hypothesis. We demonstrated that any practice improves novices’ performance. However, as the amount of information increases (more contextualized), improvement in practice is not as great as in decontextualized practice. This finding suggests that educators designing a curriculum should carefully take into consideration what aspects of the context should be adjusted in order to facilitate novices’ learning. Conclusion: Depending on the skill level of learners, conditions of practice can make tasks more or less difficult by influencing the amount of available information. To inform the design of simulation-based training of basic surgical skills to provide a more effective learning experience for trainees, the effects of contextualization should be further tested with a larger group of participants or more advanced trainees.