Residency training in the field of orthopaedic surgery is undergoing a tremendous paradigm shift. With increasing restrictions on work hours, the development of advanced arthroscopic skills and techniques may be adversely affected. In 2003 new regulations concerning resident duty hours were established by the Accreditation Council for Graduate Medical Education (ACGME). These changes included, among other rules, the implementation of the 80-hour work week. A growing concern over resident fatigue and

potential compromise of patient care was instrumental in establishing these new regulations. Eight years later, in 2011, the ACGME again instituted new regulations, including limiting interns to no more than 16 continuous hours per duty period with a mandatory rest period of 8 hours (10 hours recommended) between duty periods, as well as mandating the presence of direct supervision. Other rules included requiring intermediate-level residents to have at least 14 hours free of duty after 24 hours of in-house call and limiting “night float” residents to a maximum of 6 consecutive nights before requiring a mandatory duty-free period.

The perception of a potentially declining resident operative experience caused, at least in part, by work- hour restrictions has been discussed in several recent survey-based studies. On the basis of the results from a national survey conducted by Immerman after the 2003 changes, both junior and senior residents believed that the new rules did not increase operative time or improve operative experience. Program directors responded similarly to the residents with regard to the impact of work-hour rules on resident operative experience. Comparable results were noted in a different survey conducted by Zuckerman with most faculty members and residents responding that the work-hour changes negatively impacted the operative experience.

On the basis of the available evidence, residents continue to express concern over the impact of work hours on operative time and experience. It can be logically assumed that these perceptions may lead to decreased confidence with surgical skills and that performance in the operating room may ultimately suffer. The hand-eye coordination and dexterity skills required to perform safe, effective, and efficient arthroscopic operations are demanding, typically requiring hours of experience in the operating room. Alternative methods for obtaining these vital skills are necessary, and simulator-based training models have seen increasing popularity. Recently, an exponential increase has been seen in the number of studies describing the outcomes of modern arthroscopic simulator training being published. Arthroscopic models exist for nearly every joint, yet the actual clinical applicability of arthroscopic training models remains unclear. Interestingly, the correlation between training on a simulator and improved performance in the operating room has been established in the general surgery literature. In 2013, for example, Gallagher performed a randomized clinical trial comparing the performance of both novices and experienced laparoscopic surgeons either with or without virtual-reality laparoscopic simulation. In both groups, despite experience level, subjects in the simulation group performed significantly better than the control subjects.

The purpose of this study was to systematically review the published literature on modern arthroscopic simulator training models to determine their ability to transfer skills learned on the model to the operating room. We hypothesized that subjects who undergo arthroscopic simulator training would show objective improvement in simulator and operating room technical skills compared with those who do not undergo training.

Full Article: Utility of Modern Arthroscopic Simulator Training Models