184 – HELP VERSUS HARM? THE EFFECT OF TRAINING FEMORAL NECK SCREW INSERTION SKILLS TO SURGICAL TRAINEES WITH COMPUTER-ASSISTED SURGERY: COMPARISON TO CONVENTIONAL FLUOROSCOPIC TECHNIQUE

Abstract

Purpose: This study attempted to determine if the form of feedback provided by a computer-based navigation technique improves the learning of the placement of cannulated screws across a femoral neck fracture in the surgical trainee.

Method: A prospective, randomized, appropriately powered, and controlled study involving 39 surgical trainees (first-year residents and fourth-year medical students) with no prior experience in surgically managing femoral neck fractures were used in the study. After a training session, participants underwent a pretest by performing the surgical task on a simulated hip fracture using fluoroscopic guidance. Immediately after, 20 participants were randomized into undergoing a training session using a conventional fluoroscopy-guided technique while the other participants were randomized into undergoing a training session using a computer-based navigation technique. Immediate post-tests and retention tests (4 weeks later) were performed. A transfer test was used to assess the impact of the type of training on surgical performance – after performing the retention test, each group repeated the task but used the other technique to guide them (i.e. those trained with fluors-copy used computer navigation and vice versa).

Results: Screw placement was equal and to the level of an expert surgeon with either training technique during the post-, retention, and transfer tests. Participants that were trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those that trained with fluoroscopy. When participants that trained with computer navigation reverted to conventional fluoroscopic technique at the transfer test, more fluoroscopy time and dosage was used. Participants that trained with fluoroscopy used less fluoroscopy time and took fewer attempts to position hardware when they subsequently used computer navigation to perform the task during the transfer test.

Conclusion: Computer navigation does not harm the learning of surgical novices in this basic orthopaedic surgical skill. Training with computer navigation minimizes radiation exposure and decreases the number of attempts to perform the task. No compromise in learning occurs if a surgical novice trains with one type of technology and transfers to using the other.