Phil Blyth

Background: Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray–guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of “see one, do one, teach one” are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. Objective: This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. Methods: This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort’s performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. Results: As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). Conclusions: This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb International Registered Report Identifier (IRRID): DERR1-10.2196/38282

PROTOCOL FOR EXAMINING TRANSFER VALIDITY OF A SUPRACONDYLAR HUMERAL FRACTURE PINNING AUGMENTED REALITY SIMULATOR

Human-cadaveric material is a valuable resource for teaching anatomy, and a lot of research engaging medical students shows they benefit, in a variety of ways, from engaging with this material. However, more and more students who study anatomy are non-medical. Thus, they may have different educational foci than that of medical students, and, therefore, different perspectives on the value of human-cadaveric material as a learning resource. The aim of this study was to explore the perceptions of science students studying anatomy, in the use of learning using cadaveric material. Two cohorts of undergraduate science students studying anatomy (second-year, third-year) completed two surveys; one at the start and another following the completion of their semester-long courses that utilised prosections (second-year) and dissection (third-year) as a primary way of learning anatomy. Likert-scale and open-ended responses were analysed using a general inductive approach, and common emergent themes were identified. In total, 134 second-year and 77 third-year students completed the first survey, and 80 second-year and 36 third-year students completed the second survey. For the majority of students, their interactions with human material were positive and most of them cope well. Students acknowledged the opportunity and expressed gratitude for an invaluable learning resource. If at first the situation is confronting, with more experience, exposure, and staff support, most students find their initial concerns dissipate. This study identifies key areas of the learning journey that work well and others that can be improved, to better prepare students for learning with human material.

BACKGROUND Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray–guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of “see one, do one, teach one” are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. OBJECTIVE This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. METHODS This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort’s performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. RESULTS As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). CONCLUSIONS This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb INTERNATIONAL REGISTERED REPORT DERR1-10.2196/38282

In response to the challenges created by the implementation of a new medical school curriculum at the University of Otago in 2008, we aimed to develop a blended learning course for teaching rheumatology within the existing musculoskeletal course. We developed a multimedia online learning resource structured to support class based problem-based learning (PBL) sessions, and enhance student engagement and promote clinical reasoning. We also aimed to align teaching over three geographically separate campuses, promote more student-centred approaches to learning and meet the challenge of the limited teaching time available for undergraduate learning in the field of rheumatology. Our redesigned course was evaluated longitudinally over eighteen months through student focus groups, Blackboard and Moodle electronic access data, and course evaluation questionnaires. The data collected indicated an overwhelmingly positive response to the changes in teaching methods. Online materials integrated into the new curriculum and combined with in-class PBL and clinical sessions, proved popular with students. Students accessed the newly developed online materials far more frequently than the previously available unstructured content, which they felt to be of limited value or relevance to their studies. Furthermore the blended learning approach allowed delivery of common content across three separate campuses.

While the potentials of virtual worlds to support experiential learning in medical education are well documented, assessment of student learning within these environments is relatively scarce and often incongruent. In this article, a conceptual framework is proposed for formatively assessing dispositional behaviours in scenario-based learning within a virtual world. The framework was devised for use with medical students playing the roles of junior doctors as they solve open-ended clinical cases within an environment called the Otago Virtual Hospital. Drawing upon Perkins, Jay and Tishman's (1993) dispositional theory of thinking, it is proposed that the assessment of dispositional behaviours in scenario-based activities can be carried out by measuring the number of times students either seize or miss an opportunity to engage in a particular dispositional behaviour. The approach can potentially also be used for assessing scenario-based learning in other disciplines (e.g. law, business, military).

There is a growing need to learn surgical skills without risk to patients. One of the major determining factors on the suitability of specimens for surgical workshops is the fluid used for embalming. This study sought to compare three different arterial embalming preparations to a single fresh cadaver. Eleven cadavers embalmed using Graz (single cadaver), Dodge (four cadavers) and Genelyn (five cadavers) preparations were compared using four criteria; joint flexibility measured with a goniometer, tissue pliability rated on standardized videos of instrument handling, tissue color analyzed on standardized photographs and resistance to fungal growth identified by inoculation and observation of tissue blocks. The cadaver embalmed according to the Graz method had joint flexibility comparable to fresh tissue while the Dodge and Genelyn cadavers were less flexible. Tissue pliability was significantly affected by the Dodge and Genelyn methods while the Graz method tissue remained most like fresh tissue. The Graz method cadaver had color that was most akin to fresh tissue and the Dodge method cadavers were relatively more like fresh than the Genelyn. The Dodge and Genelyn method had quite similar fungicidal properties (3/11 Dodge and 2/9 Genelyn embalmed cadavers susceptible) while the Graz method cadaver did not grow mould. Variation exists between cadavers; however, the Graz method produced a cadaver with more flexible joints, better tissue quality and muscle color closest to the fresh specimen. The Dodge and Genelyn methods are similar with the exception of tissue color where the Dodge method was more similar to fresh tissue. Clin. Anat. 24:155–161, 2011.

To date virtual reality simulations of operative procedures have been extensively tested and utilised by advanced surgical trainees. The increasing number of medical students has meant that the amount of exposure to surgical procedures is reducing, and direct involvement of the medical student within those procedures is decreasing. The Bonedoc DHS Simulator for fixing hip fractures was trialled within the orthopaedic attachment. An online questionnaire was completed by 31 fifth year medical students, the control group of 17 students had no exposure to the simulator, and 14 students had access to the simulator. Despite similar operative exposure, the intervention group scored significantly higher on understanding key aspects of hip fracture. The simulator did not in itself stimulate interest in orthopaedics (3 of 14 students). Unfortunately tight security on hospital computers restricted students’ use of the simulator. Twenty-four hour access to the simulator was deemed important (9 students agreed, 0 disagreed, 5 unanswered).