Training outside of the operating room improves intern resident psychomotor skills on a validated ASSH tool

Abstract

• Given work restrictions, orthopaedic training is increasingly dependant on surgical simulation. • STEP modules is a low cost simulation for psychomotor skills in hand surgery. • STEP training with limited supervision improved performance in certain modules. • The STEP simulator may be valuable for resident education and assessment. The Surgical Training and Educational Platform (STEP) was developed by the American Society for Surgery of the Hand (ASSH) as a cost-effective set of surgical simulation modules designed to represent critical psychomotor skills in hand surgery. We hypothesize that increased training on these training modules, even with limited supervision, would improve resident performance on psychomotor skills. Baseline evaluation was conducted on four psychomotor skills to simulate surgical tasks: lag screw fixation, depth of plunge, skin graft harvest, and wrist arthroscopy. One-third of them received limited supervised training for one month and two-thirds did not (control). After the training period both groups were re-evaluated and their performance was analysed. Six ACGME accredited orthopaedic surgery residency programs. All 26 residents in the intern bootcamp participated and completed the study. Selection to the Trained Group was based on willingness and ability to participate. Others remained in the Control Croup. Compared to baseline, the Control Group performed worse in depth of plunge while showing no improvement in other tasks in the final assessment. Compared to baseline, the Trained Group improved in lag screw fixation and in total score after training, with the greatest improvement in the half with the lowest pre-training scores. Post-training, the Trained Group outperformed the Control Group in depth of plunge. Training outside the operating room even with limited supervision improved psychomotor skills in orthopaedic surgery interns as assessed by the STEP modules. The STEP simulator is a validated instrument and may be valuable for resident education and assessment.