Arthroscopic Shoulder Simulation: Can a Computer Perceive Expertise? (SS-61)

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It is imperative for orthopaedic surgeons to develop and retain arthroscopic surgical skills to maintain peak performance levels. As new surgical simulators begin to become more commonplace in training there is a need to validate the model’s scoring system in perception of expertise of the user. The purpose of this study was to evaluate the biometric scoring system of a virtual reality arthroscopic simulator (ArthroVR [Simbionix USA Corporation/GMV, Cleveland, OH]) in respect to whether scores were accurate reflections of the experience of the surgeon. 41 subjects of various levels of arthroscopic shoulder experience including residents, fellows and attending surgeons were recruited to participate in this study. Each subject completed two different simulator tasks on the Arthro VR simulator. The participants were asked to do two tasks, a Bankart screw placement and a basic probe exam. All participants were asked their years of clinical practice, number of shoulder arthroscopies performed per year and their level of simulator experience. A global score was assigned for each exam based on the biometric scoring system built into the simulator. In both the probe exam and Bankart screw placement there was a 0.025 and 0.175 Pearson correlation coefficient, respectively, between the number of years in practice and the total score. There was a 0.207 and 0.323 correlation with the scoring on the probe exam and Bankart screw placement with number of scopes done in a year. This study questions the validity of the metrics used by the ArthroVR scoring system in its role in evaluation of the surgeon. In addition, this study questions its use as a measurement device in future studies. The post-test questionnaire showed that the participants felt that the simulator provided realistic haptic feedback and the instrument usage and motion were realistic. The results indicate a need for a better metrics-scoring model in the virtual arthroscopy simulator model as we increasingly use the simulators to assess residents and fellows and evaluate progress in mastering techniques in arthroscopic surgery. It is notable that the simulator is an important tool in arthroscopy training and we must continue to utilize it is as a way to prepare resident and fellows.