Setting proficiency standards for simulation-based mastery learning of short antegrade femoral nail osteosynthesis: a multicenter study

• Published in: Acta orthopaedica 2024-05, Vol.95, p.275-281
• Main Authors: Gustafsson, Amandus, Rölfing, Jan D, Palm, Henrik, Viberg, Bjarke, Grimstrup, Søren, Konge, Lars
• Format: Article
• Language: English
• Subjects: Adult; Assessment; Bone Nails; Clinical Competence; Denmark; Education; Female; Fracture Fixation, Internal - education; Fracture Fixation, Internal - methods; Fracture Fixation, Intramedullary - education; Fracture Fixation, Intramedullary - methods; Fractures; Hip; Hip Fractures - surgery; Humans; Male; Mastery learning; Mastery standard; Orthopedics - education; Simulation Training - methods
• ISSN: 1745-3674; 1745-3682; 1745-3682
• DOI: 10.2340/17453674.2024.40812

Orthopedic trainees frequently perform short antegrade femoral nail osteosynthesis of trochanteric fractures, but virtual reality simulation-based training (SBT) with haptic feedback has been unavailable. We explored a novel simulator, with the aim of gathering validity evidence for an embedded test and setting a credible pass/fail standard allowing trainees to practice to proficiency. The research, conducted from May to September 2020 across 3 Danish simulation centers, utilized the Swemac TraumaVision simulator for short antegrade femoral nail osteosynthesis. The validation process adhered to Messick's framework, covering all 5 sources of validity evidence. Participants included novice groups, categorized by training to plateau (n = 14) or to mastery (n = 10), and experts (n = 9), focusing on their performance metrics and training duration. The novices in the plateau group and experts had hands-on training for 77 (95% confidence interval [CI] 59-95) and 52 (CI 36-69) minutes while the plateau test score, defined as the average of the last 4 scores, was 75% (CI 65-86) and 96% (CI 94-98) respectively. The pass/fail standard was established at the average expert plateau test score of 96%. All novices in the mastery group could meet this standard and interestingly without increased hands-on training time (65 [CI 46-84] minutes). Our study provides supporting validity evidence from all sources of Messick's framework for a simulation-based test in short antegrade nail osteosynthesis of intertrochanteric hip fracture and establishes a defensible pass/fail standard for mastery learning of SBT. Novices who practiced using mastery learning were able to reach the pre-defined pass/fail standard and outperformed novices without a set goal for external motivation.