Virtual Flexor Tendon Repair Surgical Training with a New Tendon Model: A Pilot Study
Kevin A Taylor, MD1; Jackie Geissler, MD2
1Minnesota Hand Surgery Fellowship, HealthPartners Institute, St Paul, MN; 2Orthopaedics, Hennepin County Medical Center, Minneapolis, MN
INTRODUCTION: Given the continued constraints on cost and safety for larger personnel gatherings in the post-COVID era, additional strategies for effective surgical trainee instruction and simulation are needed. The following study was designed to trial the effectiveness and validity of a new flexor tendon educational model that can be completed virtually.
MATERIALS & METHODS: A trial cohort of ten medical students and orthopaedic residents participated in the trial. A flexor tendon model using silicone tubing was developed to allow a reproducible, low-cost surrogate for tendon repair (Fig. 1). Suture materials and instructional packets were mailed to each candidate and they were instructed to perform various repair techniques (Modified Kessler, Figure of 8, Cruciate, Bunnell) before and after watching an online video tutorial. Repaired models were returned both electronically by photograph and physically by mail for evaluation. Performance was graded on a three-tiered proficiency ordinal scale from ‘unacceptable’ to ‘proficient’ by a panel of hand-fellowship trained faculty members. Additionally, participants completed a pre- and post-exercise survey to rate their ability for each suture technique using a Modified Dreyfus Scale for skill development. Improvement in performance as judged by the faculty raters and trainees was analyzed using descriptive statistics and nonparametric testing (Mann Whitney U, Wilcoxon signed rank). Inter- and intraobserver reliabilities between faculty members rating physical or photographed tendon models were determined using weighted Cohen’s Kappa values.
RESULTS: Trainees reported a significant increase in flexor tendon repair proficiency after completing the virtual model. Faculty members also noted improvement in repair execution, with all collected post-training specimens achieving a functional repair status. Largest gains were achieved for tendon specific stitch configurations (Fig. 2). Faculty members were able to demonstrate excellent internal reliability (k>0.84) and moderate to good interobserver reliability (k=0.51-0.61).
CONCLUSIONS: The proposed virtual training model improved trainee confidence and performance in executing flexor tendon repair techniques. Faculty evaluations were consistent and had good agreement between raters. This technique may offer a new alternative for enhancing hand surgical education and could potentially be free from in-person instruction.
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