Surgical Priming Improves Operative Performance in Surgical Trainees: A Crossover Randomized Control Trial

OBJECTIVE: The aim of this study was to evaluate the impact of a surgical warm-up using a virtual reality simu-lator on operative performance. DESIGN: This was a single-blinded cross-over random-ized control trial in a single tertiary Orthopedic training center. PARTICIPANTS: Orthopedic trainees were recruited, and each morning participants rostered to theatre were randomized to either undergo a simulated surgical proce-dure on a virtual reality simulation system prior to their first case as primary operator (priming arm), or to per-form their usual preparatory routine for surgery (control arm). Consultant orthopedic trainers were recruited within the orthopedic unit to carry out subjective surgi-cal performance assessments using a validated global rat-ing scale tool on the first case the participant performed on the list as primary operator. RESULTS: Over 3 study periods a total of 151 data points were collected, with 49 matched data points across priming status and procedural level of difficulty. Subjec-tive assessment tools consistently demonstrated improved operative performance by participants follow-ing surgical priming (p = 0.001). CONCLUSION: This study highlights that introduction of preoperative priming to improve operative prepara-tion, and optimizes operative performance. This has not only implications for improved resident training, but also signals towards beneficial downstream effects on patient outcomes, and theatre list planning. (J Surg Ed 80:420-427. (c) 2022 The Author(s). Published by Elsev-ier Inc. on behalf of Association of Program Directors in Surgery. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/))