Efficacy of a Virtual Arthroscopic Simulator for Orthopaedic Surgery Residents by Year in Training

Background: Virtual reality arthroscopic simulators are an attractive option for resident training and are increasingly used across training programs. However, no study has analyzed the utility of simulators for trainees based on their level of training/postgraduate year (PGY). Purpose/Hypothesis: The primary aim of this study was to determine the utility of the ArthroS arthroscopic simulator for orthopaedic trainees based on their level of training. We hypothesized that residents at all levels would show similar improvements in performance after completion of the training modules. Study Design: Descriptive laboratory study. Methods: Eighteen orthopaedic surgery residents performed diagnostic knee and shoulder tasks on the ArthroS simulator. Participants completed a series of training modules and then repeated the diagnostic tasks. Correlation coefficients (r(2)) were calculated for improvements in the mean composite score (based on the Imperial Global Arthroscopy Rating Scale [IGARS]) as a function of PGY. Results: The mean improvement in the composite score for participants as a whole was 11.2 +/- 10.0 points (P = .0003) for the knee simulator and 14.9 +/- 10.9 points (P = .0352) for the shoulder simulator. When broken down by PGY, all groups showed improvement, with greater improvements seen for junior-level residents in the knee simulator and greater improvements seen for senior-level residents in the shoulder simulator. Analysis of variance for the score improvement variable among the different PGY groups yielded an f value of 1.640 (P = .2258) for the knee simulator data and an f value of 0.2292 (P = .917) for the shoulder simulator data. The correlation coefficient (r(2)) was -0.866 for the knee score improvement and 0.887 for the shoulder score improvement. Conclusion: Residents training on a virtual arthroscopic simulator made significant improvements in both knee and shoulder arthroscopic surgery skills. Clinical Relevance: The current study adds to mounting evidence supporting virtual arthroscopic simulator-based training for orthopaedic residents. Most significantly, this study also provides a baseline for evidence-based targeted use of arthroscopic simulators based on resident training level.