Evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool in a real-time simulation setting (Distributed Interactive Simulation): a randomized controlled trial. Issue 11 (November 2021)

• Record Type: Journal Article
• Authors: Bhattacharyya, Rahul; Al-Obaidi, Bilal; Sugand, Kapil; Bhattacharya, Rajarshi; Gupte, Chinmay M
• Is Part Of: Injury. Volume 52:Issue 11(2021)
• Page Start: 3420
• Page End: 3426
• Publication Date: 2021-11
• Subjects: Femoral Nailing Cognitive Task Analysis tool -- Simulation training -- Randomized controlled trail -- Distributive Interactive Simulation; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.02.090
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: This study has demonstrated objective benefits of a novel femoral nailing CTA tool in the enhancement of practical skills for junior residents in the Distributive Interactive Simulation (DIS) setting. This tool can be accessed remotely, is contact free and allows repeated sustained practice which is key in simulation training. The importance of this is further highlighted by the restrictions placed on surgical training for the foreseeable future by the COVID-19 pandemic. This is the first study reporting the use of real time simulation (DIS) as an assessment modality in orthopaedic training. Abstract: Introduction: Working time regulations, senior led service delivery and increasing complexity of surgical technology has led to significant strains in surgical training. Additionally, the current COVID-19 pandemic has placed substantial limitations on surgical training worldwide. Contact free, remote, web-based, validated learning tools which are easily accessible and allows repeated, sustained practice are the need of the hour. Cognitive Task Analysis (CTA) have been used extensively to train pilots and military personnel and has shown excellent early results within orthopaedic training. We designed a femoral nailing CTA tool which showed objective benefits in the enhancement of cognitive knowledge in medical students. The aim of this study was to evaluate the effectiveness of this CTA tool to enhance practical skills in orthopaedic trainees in a real time interactive simulation setting (Distributed Interactive Simulation (DIS)). Methods: This was a double blinded, randomized controlled trial. 14 junior orthopaedic residents who met the inclusion criteria were recruited in the study. They were randomized into two equal groups. The intervention group were given the CTA learning tool, the control group were given a standard operative technique manual used for antegrade femoral intramedullary nailing. The participants were assessed on a high-fidelity phantom femur model with actual femoral nailing instruments in a simulation mobile operating theatre where the candidate had a simulation patient, an acting anesthetist and a scrub nurse (DIS). They were assessed using the modified Objective Structured Assessment of Technical Skills (OSATS) rating scale which has been validated for orthopaedic trauma. Results: The median OSATS score in the intervention group was 49 (±4.93, range 39-55) compared to 17 in the control group (±14.98, range 12-51). The median improvement was by 32 points (p = 0.02). The ICC between the two raters was 0.977. Conclusions: This study has demonstrated objective benefits of a novel femoral nailing CTA tool in the enhancement of practical skills for junior trainees in the DIS setting. This adds to the growing evidence supporting the use of CTA in orthopaedic training. This tool can be accessed remotely, is contact free and allows repeated sustained practice which is key in simulation training.