Surgical simulation for metacarpal fracture fixation improves satisfaction, confidence and skill
Rajiv Iyengar, MD, Yale University, New Haven, CT, Albert Woo, MD, Brown University, Providence, RI and Adnan Prsic, MD, Yale School of Medicine, New Haven, CT
Introduction: Surgical education has long touted the value of high fidelity simulations in the modern training paradigm. The senior authors of this study have therefore created a low-cost model of a human hand using 3D printing and silicone molding to facilitate at-home practice sessions for K-wiring.
Materials and Methods: Following IRB review and approval, 11 plastic surgery residents (PGY 1-6) were recruited for this study. All residents watched a presentation from the senior author (A.P.), which outlined 10 steps to K-wire fixation. Residents were divided into Groups A and B, in which Group A performed K-wire fixation and Group B observed. Residents were instructed on placing a K-wire retrograde through the MCP head of the middle finger. They were then timed on placement of two K wires diagonally across the fracture. The groups then crossed over. The residents were then instructed to perform four practice sessions at home prior to the next assessment. Confidence and satisfaction data in a 15 question survey were recorded using a Likert scale from 1-5, with 5 corresponding to strong agreement. Aggregate scores are represented in parentheses below.
Results: All residents agreed that the model was realistic (4.77), sufficient for fracture identification (4.52) and had appropriate approximation of soft tissue and bony tactile feedback (4.34). Moreover, all residents agreed about the benefits of using 3D models for other areas of hand surgery (4.87), noting that they found these session stimulating (4.93). All residents would recommend this model to other trainees (4.78) and reported feeling that they had learned valuable skills (4.61); all residents also endorsed the utility of the lecture prior to the first session (4.12). Most residents had scrubbed either 0-5 or 6-10 cases requiring K wiring. All residents felt more confident with K-wiring following the practice sessions when compared to pre-training baselines (2.73 vs. 4.38). Times were stratified by PGY level; PGY 1-4 (n = 8) average times Session 1 was 712 seconds and 433 seconds for Session 2, while PGY 5-6 (n = 3) times were 495 seconds and 247 seconds respectively (p = 0.037).
Conclusions: Our analysis demonstrates that residents universally approved of and benefitted from the K wiring instructional session and practice model. The time improvement was statistically significant. We therefore believe that this is a practical and efficacious model to improve a critical skill in hand surgery across training levels.
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