Psychomotor Skills Training Research Articles

Medical education during the COVID-19 pandemic: An online-only course can achieve good to medium psychomotor skill level of basic head and neck examination

Background/ObjectivesNew teaching methods are warranted to meet the demand for increased flexibility in medical education while making optimal use of the limited resources of educators. The COVID-19 pandemic forced universities to resort to online-only teaching, even for training of psychomotor skills. The objectives of this study were: (I) to investigate the performance of students without previous experience in ear, nose and throat (ENT) examination after completing an asynchronous online teaching course in an objective standardized clinical examination (OSCE) and (II) to evaluate the degree of over- and underestimation of their abilities. MethodsThe study was designed as a prospective, single-institution medical education cohort study. Medical students (n = 54; 3rd/4th year, no previous head and neck examination skills) completed a comprehensive online training for basic head and neck examination skills 1–14 days before undergoing an OSCE on 5 different examination items (cervical lymph node examination, oral/oropharyngeal examination, otoscopy, Weber/Rinne hearing test, anterior rhinoscopy). Expert-evaluated theoretical knowledge and practical abilities were measured using Likert scales (1 = high proficiency to 5 = low proficiency). Participants self-evaluated their own skills before and after the OSCE (5-point Likert scales). ResultsStudents achieved an overall good to medium skill level in basic head and neck examination after online training. Increased psychomotor complexity of tasks contributed to worse performance. Expert evaluation of practical skills was better in male participants and those who rated their preparation as thorough. Low/no misjudgment (discrepancy between self- and expert-evaluation) was observed in most participants, while high discrepancy levels (strong misjudgment) were mainly attributable to the students’ underestimation of their own abilities. ConclusionsOnline training of head and neck examination skills is a cost- and resource-efficient introduction to skill training and was inevitable during the pandemic. However, it cannot replace practical hands-on training, especially in tasks with high psychomotor requirements. Refresher-courses could compensate for cancelled skill training during the pandemic.

A Review of Recent Literature on Audio-Based Pseudo-Haptics

Immersive virtual learning environments (iVLEs), particularly serious games and virtual simulations, typically ignore psychomotor skills development, partly due to the difficulty and cost associated with accurately replicating touch. Simulating touch, also known as haptics, requires specialized haptic devices that are not widely accessible at the consumer-level. Using visual (and/or auditory) cues, pseudo-haptics aims to mimic touch sensations without haptic devices. Although pseudo-haptics has predominantly focused on visual cues, a 2019 review by Collins and Kapralos on pseudo-haptics emphasized the role of auditory cues and cross-modal interactions. Since then, great advancements, notably during the COVID-19 pandemic’s shift to remote learning, have been made. Here, we build upon the work of Collins and Kapralos with a narrative review on audio-based pseudo-haptics. This narrative review explores 17 articles obtained from the Google Scholar, RefSeek, Scopus, and PubMed databases, with the aim of providing a comprehensive summary of the progress in this field since 2019. Pseudo-haptics presents a viable alternative to simulate various aspects of touch, including weight, stiffness, roughness, dampness, force, and glossiness, when haptic devices are unavailable, enhancing immersion and providing the potential to improve psychomotor skill training within iVLEs.

Teaching Psychomotor Skills in Undergraduate Nursing Education: An Integrative Review.

Psychomotor skills, a cognitive and fine motor process, are an essential component to undergraduate nursing education. Currently, no national guidelines exist to guide nursing programs on the best way to educate students to ensure competent and safe practice of psycho-motor skills in the clinical setting. This review sought to determine what methods of education, training, and practice of psychomotor skills enhanced psychomotor skill competency in undergraduate nursing students. An integrative review was conducted to determine teaching and practice strategies to support psychomotor skill competence. Four significant categories were identified and included (1) simulation; (2) technology; (3) deliberate practice; and (4) theoretical and collaborative instruction. Overall, simulation and technology were found to be the most effective in psychomotor skill competence. Additional research is needed to identify which teaching strategies best support nursing students' long-term knowledge acquisition and competency as they transition into professional practice. [J Nurs Educ. 2024;63(7):421-426.].

Effectiveness of structured self-evaluation of video recorded performance on peripheral intravenous catheter insertion: a randomised control trial study protocol

BackgroundClinical psychomotor skills training is a core component of undergraduate nursing education. Performing technical skills competently involves the use of cognitive and motor function. The training of these technical skills is typically carried out in clinical simulation laboratories. Peripheral intravenous catheter/cannula insertion is an example of a technical skill. It is the most common invasive procedure performed in the healthcare environment. Owing to unacceptable clinical risk and complications to patients, it is imperative that practitioners performing these skills are trained effectively to provide patients with best practice and high-quality care. Technologies identified as innovative teaching methods to help train students in this skill and in the skill of venepuncture include virtual reality, hypermedia and simulators. However, little high-quality evidence exists to confirm such educational approaches are effective.Methods/designThis study is a single-centre, non-blinded, two-group, pre-test and post-test randomised control trial. The randomised control trial will investigate whether a formal structured self-evaluation of videoed performance (experimental group) has an impact on nursing students’ peripheral intravenous cannulation knowledge, performance and confidence. The control group will also be videoed performing the skill but they will not view or self-evaluate their videoed performance. The peripheral intravenous cannulation procedures will be carried out in a clinical simulation laboratory using a task trainer. The data collection tools will be completed online using survey forms. Students will be randomised into the experimental group or into the control group using simple random sampling. The primary outcome measures the nursing students’ knowledge level of the skill of peripheral intravenous cannulation insertion. Secondary outcomes evaluate procedural competence and self-reported confidence and practices in the clinical environment.DiscussionThis randomised control trial will investigate whether this pedagogical approach, using video modelling and self-evaluation, will positively influence students’ knowledge, confidence and performance in the skill of peripheral intravenous cannulation. Evaluating such teaching strategies using stringent methodologies may be impactful in influencing the training provided to healthcare practitioners.Trial registrationThe randomised control trial detailed in this article is an educational research study and so does not fall under the ICMJE definition of a clinical trial as “any research project that prospectively assigns people or a group of people to an intervention, with or without concurrent comparison or control groups, to study the relationship between a health-related intervention and a health outcome”.

Osteopathic Manipulation Skills Training: Past, Present, and Future

Abstract This article reviews the methods used to teach osteopathic manipulative treatment (OMT) from the inception of the profession in the 19th century through the 21st century. Past and current osteopathic literature contains very few references to psychomotor skills training methods used in the OMM lab. Faced with this paucity of information, suggestions for improving the traditional demonstration/imitation model of instruction are given. These suggestions are derived from the science of learning (SL), Simulation-Based Medical Education (SBME), Evaluation Science (EV), and insights gleaned from sim lab student assessment research. The future of osteopathic pedagogy is discussed in relation to advances in neuroscience, technology, and the need to preserve the uniqueness of the osteopathic profession. Kirkpatrick’s method of training evaluation is suggested as a paradigm for assessing curriculum changes and measuring goals set on departmental, college and professional levels.

Haptic and Force Feedback Technology in Dental Education: A Bibliometric Analysis.

The haptic and force feedback technology has received an increasing attention in dental schools due to its effectiveness in psychomotor skill training. However, the bibliometric analysis on haptic and force feedback technology in dental education is still scarce. Therefore, the aim of this study was to perform a bibliometric analysis of the development of haptic and force feedback technology and its changing trends in dental education. From 1 January 2001 to 30 November 2022, all papers published on haptic and force feedback technology were searched from the Web of Science Core Collection database. These data were then entered into Apple Numbers for descriptive bibliometric analysis and visualized using VOSviewer software. A total of 85 articles were retrieved following the inclusive and exclusive criteria. The results demonstrated that USA and China exhibited the most publications. The combination of correspondence author and author co-citation analysis identified the more prominent authors in this research field. The top-cited and the average citation count per year ranking led to different views of popularity. A significant increase in the number of haptic and force feedback technology publications were found in the last two years. Virtual reality is the main keyword that indicates more new integrative applications currently underway. Taken together, this study provides a detailed bibliographic analysis of haptic and force feedback technology in dental education to indicate representative authors, literatures, keywords, and trends. These detailed data will help researchers, teachers, and dental students as a very useful information when trying to make haptic and force feedback technology more prevalent in dental education in the near further.

Attitude and Satisfaction towards Video-Based Psychomotor Skill Training in the Skill Laboratory among Undergraduate Nursing Students

Attitude and Satisfaction towards Video-Based Psychomotor Skill Training in the Skill Laboratory among Undergraduate Nursing Students

Face, content, and construct validity of the virtual immersive operating room simulator for training laparoscopic procedures.

The aim of this work is to present the face, content, and construct validation of the virtual immersive operating room simulator (VIORS) for procedural training of surgeons' laparoscopic psychomotor skills and evaluate the immersive training experience. The VIORS simulator consists of an HMD Oculus Rift 2016 with a visor on a 1080 × 1200 pixel OLED screen, two positioning sensors with two adapted controls to simulate laparoscopic instruments, and an acrylic base to simulate the conventional laparoscopic setup. The immersion consists of a 360° virtual operating room environment, based on the EndoSuite at Hospital Infantil de Mexico Federico Gomez, which reproduces a configuration of equipment, instruments, and common distractions in the operating room during a laparoscopic cholecystectomy procedure. Forty-five surgeons, residents, and medicine students participated in this study: 27 novices, 13 intermediates, and 5 experts. They completed a questionnaire on the realism and operating room immersion, as well as their capabilities for laparoscopic procedural training, scored in the 5-point Likert scale. The data of instrument movement were recorded and analyzed using 13 movement analysis parameters (MAPs). The experience during training with VIORS was evaluated through NASA-TLX. The participants were enthusiastic about the immersion and sensation levels of the VIORS simulator, with positive scores on the realism and its capabilities for procedural training using VIORS. The results proved that the VIORS simulator was able to differentiate between surgeons with different skill levels. Statistically significant differences were found in nine MAPs, demonstrating their construct validity for the objective assessment of the procedural laparoscopic performance. At cognitive level, the inversion experience proves a moderate mental workload when the laparoscopic procedure is carried out. The VIORS simulator has been successfully presented and validated. The VIORS simulator is a useful and effective device for the training of procedural laparoscopic psychomotor skills.

The Effect of Distance Educationon the Professional Competence and Academic Motivation of Midwifery Students: A Qualitative Study

With the COVID-19 pandemic, the online teaching model has been used for the first time, and this has led to significant changes in departments such as midwifery, where theory and practice are combined. This study aimed to determine the effect of distance education on the professional competence and academic motivation of midwifery students. This study was carried out at a national university in Kastamonu, Türkiye between March and September 2021. The study adopted a qualitative design, and participants (n = 20) were the third-year midwifery students. Data were collected by conducting in-depth semi-structured face-to-face interviews using a pilot-tested interview guide. The interviews were conducted through webinars and the interviews were recorded. The interviews were held in a relaxed and calm environment where both researchers were present. The interviews were conducted with no more than two students in one day and the interview records were transcribed on the same day. Each interview lasted about 40 minutes. The researchers followed a systematic data analysis procedure which is an appropriate method of analysis when aiming to create knowledge based on experiences and meanings from cross-case analysis. The third-year midwifery students closest to graduating from the Faculty of Health Sciences participated in the study. With the individual and in-depth interviews, the responses of the midwifery students were subsumed under the following six themes: (1) ‘a new learning experience, (2) reluctance to learn new information, (3) inadequacy in professional skills, (4) lack of self-confidence, (5) not being able to join a multidisciplinary team, (6) anxiety about future professional life'. It has been determined that distance education in midwifery education in Türkiye has many pleasing and facilitating features as well as obstructive and worrying aspects. In addition, online education negatively affected the psychomotor skill development of students. It is recommended that institutions providing education to midwifery students be aware of the difficulties experienced and follow different methods for psychomotor skills training.

Review of "Evidence-based Guidelines on the Use of Virtual Surgical Education Pertaining to the Domains of Cognition and Curriculum, Psychomotor Skills Training, and Faculty Development and Mentorship". Park, Keon Min et al Annals of Surgery . 2022;276(1):e6-e15.

The Journal of Craniofacial Surgery ():10.1097/SCS.0000000000008922, August 15, 2022. | DOI: 10.1097/SCS.0000000000008922

The Effect of Distance Education Conducted during the COVID-19 Pandemic Period on the Psychomotor Skill Development of a Dental School Students.

Purpose This study compared the development of face-to-face (F2F) psychomotor skills vs. a modified online dental anatomy course during the COVID-19 pandemic. Methods The 9-HPT is regularly applied for the students' psychomotor skill assessment in the Faculty of Dentistry of Süleyman Demirel University. In the 2020-21 academic year, 92.2% of students who took the dental anatomy course in distance education voluntarily participated in this study (observation group). These data were compared with 34.6% of students who applied for 9-HPT in 2019-2020 in F2F education (control group). The Mann–Whitney U test and t-test were used for comparison. The significance level was taken as p < 0.05. Results Based on the dominant hand 9-HPT score, a positive change occurred in 81.8% of the F2F and 61.6% of the online education students. Based on both dominant and nondominant hand 9-HPT scores, a statistically significant difference between the change in scores according to the fall/spring term measurements was observed in both F2F and distance education (p < 0.001). However, the F2F-educated group students showed better psychomotor skill development than those exposed to the online-educated group in 9-HPT. The results showed statistical significance for both dominant and nondominant hands (p < 0.001). Conclusion The F2F education is the gold standard in psychomotor skill training; however, in cases where this approach cannot be realized, practical training protocols modified for online training may contribute to the motor development of students.

EFFECTS OF ARTIFICIAL INTELLIGENCE ON THE FUTURE OF HEALTH: A QUALITATIVE STUDY AMONG UNIVERSITY STUDENTS

To determine the opinions of university students about the effects of artificial intelligence on the future of nursing and healthcare. Artificial intelligence-generated changes will have a major impact on healthcare and nursing. In-depth qualitative interviews were conducted with university students. The study included 12 senior-level students’ participants, who were selected by simple random sampling from different departments of Turkish universities in Istanbul. The data were analyzed using qualitative thematic analysis. The participants defined artificial intelligence in terms of robots, robotized intelligence, machine learning and personal assistants. The participants listed the effects of artificial intelligence on nursing as a decrease in the number of nurses, a reduced workload for nurses, more effortless patient follow-up, a decreased margin of error, the use of robots for patient transport, the use of robots to position patients, the use of robots to measure vital signs, the use of robots in psychomotor skill training, use of robots in surgical operations, use of robots in elderly care and follow-up. In line with these results, it can be recommended that new subjects on artificial intelligence and its role in the future of healthcare be added to relevant educational programs. Nurse educators should develop courses in the curriculum that will increase student awareness of artificial intelligence.

Development of the fundamentals of thoracic robotic surgery curriculum.

A great technological revolution in surgery occurred with the introduction of laparoscopic and other minimally invasive procedures, with enormous patient benefits. Robotic-assisted surgery (RAS) is a form of minimally invasive surgery that overcomes some of the limitations of laparoscopic techniques. Until recently, there were few standardized curricula for RAS. The Fundamentals of Robotic (FRS) developed a process through expert consensus conferences to develop an effective and validated curriculum for basic robotic surgery. A specialty specific curriculum for thoracic robotic surgery is also needed. The Fundamentals of Thoracic Robotic Surgery (FTRS) Consensus Conference brought together expert thoracic surgeons to build upon the accomplishments of FRS and incorporate the experiences of thoracic societies and academic institutions to establish a standardized FTRS curriculum for the development and maintenance of specialty-specific robotic surgical skills. A task deconstruction was completed for the thoracic ‘signature’ procedure, the lobectomy and training items and potential errors were identified for each step of the procedure. A final outline of the FTRS curriculum was developed during the conference and physical and virtual reality thoracic surgery training models were discussed. Following the conference, the steering committee completed the FTRS curriculum with editorial review from all stakeholders. The FTRS consensus conference followed the validated FRS model but in an accelerated process due to important groundwork set by experts in the FRS consensus conferences. A full online curriculum and supporting psychomotor skills training and team communication has been developed for the lobectomy procedure.

Faculty development program for coaching in nursing education: A curriculum development process study

Aim/objectiveThis study aims to develop a Faculty Development Program for Coaching that can be used in teaching psychomotor skills in nursing education. BackgroundKnowledge, skills and attitudes of faculty members play a significant role in students acquiring basic nursing psychomotor skills before clinical training. DesignIt is a curriculum development process study. MethodsThe study sample comprised 149 nursing faculty members in all nursing faculties in Turkey. This study combines the Delphi survey, analysis of psychomotor skills training programs and a literature review with the Triangulation Strategy. ResultsA Faculty Development Program for Coaching consisting of six modules and 34-hours was developed. The program including various teaching strategies. Participant’s achievements are assessed by grading individual assignments. ConclusionsThe Faculty Development Program for Coaching was developed to be used in all nursing faculties. When this faculty development program is implemented, it will enable researchers to make national and international comparisons in this field.

Multiple facets of learning a skill - Amalgamation of learning theories in cadaveric surgical skill lab.

Multiple facets of learning a skill - Amalgamation of learning theories in cadaveric surgical skill lab.

Evidence-based Guidelines on the Use of Virtual Surgical Education Pertaining to the Domains of Cognition and Curriculum, Psychomotor Skills Training, and Faculty Development and Mentorship.

To identify, categorize, and evaluate the quality of literature, and to provide evidence-based guidelines on virtual surgical education within the cognitive and curricula, psychomotor, and faculty development and mentorship domains. During the coronavirus disease 2019 pandemic, utilizing virtual learning modalities is expanding rapidly. Although the innovative methods must be considered to bridge the surgical education gap, a framework is needed to avoid expansion of virtual education without proper supporting evidence in some areas. The Association for Surgical Education formed an ad-hoc research group to evaluate the quality and methodology of the current literature on virtual education and to build evidence-based guidelines by utilizing the SiGN methodology. We identified patient/problem-intervention-comparison-outcome-style questions, conducted systematic literature reviews using PubMed, EMBASE, and Education Resources information Center databases. Then we formulated evidence-based recommendations, assessed the quality of evidence using Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle-Ottawa Scale for Education, and Kirkpatrick ratings, and conducted Delphi consensus to validate the recommendations. Eleven patient/problem-intervention-comparison-outcome-style questions were designed by the expert committees. After screening 4723 articles by the review committee, 241 articles met inclusion criteria for full article reviews, and 166 studies were included and categorized into 3 domains: cognition and curricula (n = 92), psychomotor, (n = 119), and faculty development and mentorship (n = 119). Sixteen evidence-based recommendations were formulated and validated by an external expert panel. The evidence-based guidelines developed using SiGN methodology, provide a set of recommendations for surgical training societies, training programs, and educators on utilizing virtual surgical education and highlights the area of needs for further investigation.

Standardized skill pass-offs and nursing student confidence: A qualitative study

The use of standardized skill pass-offs or skills check-offs and the ability to critically think are vital in the development of confident and competent nurses. At a university in the Intermountain West, basic psychomotor skill training begins the first semester of the associate nursing program and is typically done through the use of demonstration and return demonstration. This qualitative cross-sectional survey was conducted to identify the nursing students’ perception of the relationship between a skill pass-off and their confidence in the clinical setting. Twenty-five students completed a four question survey related to skill pass-off and student confidence. The results of this study indicated that while skill pass-offs did provide students with repetition and knowledge of the supplies needed to complete the skill, the feeling of confidence did not occur until the student practiced in the clinical environment. The outcome of this study emphasizes the importance of students’ experiences in the clinical setting.

Psychomotor skills development for Veress needle placement using a virtual reality and haptics-based simulator

PurposeVeress needle (VN) insertion, if not correctly performed, could cause severe injuries to intra-abdominal organs and vessels. Therefore, cognitive and psychomotor skills training is needed. Virtual reality (VR) and haptic technologies have the potential to offer realistic simulations.MethodsWe developed a novel VR and haptic surgical simulator for VN insertion to teach trainees how to correctly puncture the abdominal wall, experiencing realistic tactile sensations throughout the simulation. The simulator allows for both procedural and realistic training. We released two different versions: the first using the OpenHaptics^{text {TM}} (OH) Toolkit and the second exploiting CHAI3D. We evaluated the learning effect using different performance indexes (time to perform the procedure, error in insertion angle, number of undesired contacts with organs) in an insertion task for both experienced urologists and students.ResultsA general improvement of the chosen performance indexes was registered in the second repetition of the task for both groups. From the questionnaires, the simulator leveraging OH provides the trainee with a more precise haptic feedback, whereas the one exploiting CHAI3D allows them to perform the procedure more easily thanks to the better visualization of the virtual environment. The results proved that the participants appreciated both implementations, and the System Usability Scale (SUS) test resulted in a “good” usability.ConclusionThe haptics-based and VR simulator has shown the potential to be an important resource for the basic urological training in obtaining the pneumoperitoneum and improving the acquisition of the necessary psychomotor skills, allowing for extended and more effective training without compromising patient safety.

Effect of a positive pressure ventilation-refresher program on ventilation skill performance during simulated newborn resuscitation

AimClinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses. MethodsSubjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10−21 mL) and rate (40–60 ventilations per minute [vpm]). Baseline and post assessments were compared for total number PPV delivered, number target PPV delivered (volume 10−21 mL), mean volume and mean rate (Wilcoxon signed-rank test, median[IQR]). ResultsTwenty-six subjects were enrolled and completed a baseline assessment; 24 (92%) completed a post-assessment; 2 (8%) were lost to follow-up. Over 3 months, a mean 3.2 (range 1–6) PPV-Refreshers/subject were completed. Compared to baseline, subjects demonstrated significant improvement for total (57 [36–74] vs. 33 [26–46]; p = 0.0007) and target PPV (23 [13–23] vs. 11 [5–21]; p = 0.024), and a significant change in mean volume (mL) (11.5 [10.2–13] vs. 13.4 [11–16]; p = 0.02) and mean rate (vpm) (54 [45–61] vs. 40 [28–49]; p = 0.019). ConclusionsA PPV-Refresher program with brief, repeated psychomotor skill practice significantly improved PPV performance with the greatest improvement in total PPV and target PPV. Additional investigation is warranted to determine optimal PPV-Refresher frequency.Registered at ClinicalTrials.gov #NCT02347241

Practicing Procedural Skills Is More Effective Than Basic Psychomotor Training in Knee Arthroscopy: A Randomized Study.

Background:Simulator-assisted arthroscopy education traditionally consists of initial training of basic psychomotor skills before advancing to more complex procedural tasks.Purpose:To explore and compare the effects of basic psychomotor skills training versus procedural skills training on novice surgeons’ subsequent simulated knee arthroscopy performance.Study Design:Controlled laboratory study.Methods:Overall, 22 novice orthopaedic surgeons and 11 experienced arthroscopic surgeons participated in this study, conducted from September 2015 to January 2017. Novices received a standardized introductory lesson on knee arthroscopy before being randomized into a basic skills training group or a procedural skills training group. Each group performed 2 sessions on a computer-assisted knee arthroscopy simulator: The basic skills training group completed 1 session consisting of basic psychomotor skills modules and 1 session of procedural modules (diagnostic knee arthroscopy and meniscal resection), whereas the procedural skills training group completed 2 sessions of procedural modules. Performance of the novices was compared with that of the experienced surgeons to explore evidence of validity for the basic psychomotor training skills modules and the procedural modules. The effect of prior basic psychomotor skills training and procedural skills training was explored by comparing pre- and posttraining performances of the randomized groups using a mixed-effects regression model.Results:Validity evidence was found for the procedural modules, as test results were reliable and experienced surgeons significantly outperformed novices. We found no evidence of validity for the basic psychomotor skills modules, as test scores were unreliable and there was no difference in performance between the experienced surgeons and novices. We found no statistical effect of basic psychomotor skills training as compared with no training (P = .49). We found a statistically significant effect of prior procedural skills training (P < .001) and a significantly larger effect of procedural skills training as compared with basic psychomotor skills training (P = .019).Conclusion:Procedural skills training was significantly more effective than basic psychomotor skills training regarding improved performance in diagnostic knee arthroscopy and meniscal resection on a knee arthroscopy simulator. Furthermore, the basic psychomotor skills modules lacked validity evidence.Clinical Relevance:On the basis of these results, we suggest that future competency-based curricula focus their training on full knee arthroscopy procedures. This could improve future education programs.