Purpose
The purpose of this study was to develop and perform the initial validation for the
Surgical Training and Educational Platform (STEP), a cost-effective psychomotor training
and assessment instrument designed to teach and evaluate fundamental skills considered
critical to competency in hand surgery.
Methods
An American Society for Surgery of the Hand (ASSH) taskforce of 13 board-certified
hand surgeons developed 8 skills considered fundamental to competency in hand surgery
including: (1) lag screw fixation of an oblique fracture, (2) depth of plunge during
bicortical drilling, (3) central axis scaphoid fixation, (4) phalangeal fracture pinning,
(5) flexor tendon repair, (6) microsurgical suturing, (7) full-thickness skin graft
harvest, and (8) wrist arthroscopy. The tasks were developed from commercially available,
nonclinical supplies at low cost. The startup cost for the entire system was less
than $600 USD, with a cost-per-trainee-assessment of approximately $25 USD. After
the tasks were finalized, 2 examiners traveled to 8 sites around the country to evaluate
93 surgeons, including 57 board-certified hand surgeons and 36 first-year orthopedic
and plastic surgical residents. Scoring criteria for each task were based on a combination
of time and clinically relevant quality metrics.
Results
Board-certified hand surgeons significantly outperformed surgical trainees on all
8 tasks, demonstrating that the STEP appropriately differentiates the skill level
of expert and novice hand surgeons.
Conclusions
The STEP is an effective simulator that encompasses a wide range of fundamental psychomotor
skills considered critical to competency in hand surgery. Although the STEP tasks
are a valuable surgical training tool, further work is required to evaluate and refine
the scoring system prior to using it as a critical evaluation of performance.
Clinical relevance
The STEP simulator is a valuable, validated instrument for resident and fellow education
and evaluation in hand surgery outside of the operating room.
Key words
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Article info
Publication history
Published online: September 30, 2020
Accepted:
July 29,
2020
Received:
September 12,
2019
Footnotes
The ASSH Surgical Simulation Taskforce: Patrick Reavey, Antony Hazel, Paige M. Fox, Dawn LaPorte, David Bozentka, Amy Moore, Ryan P. Calfee, Tamara D. Rozental, Sanjeev Kakar, Jacques Hacquebord, Duretti Fufa, James Clune, and Ranjan Gupta.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Corresponding author: Ranjan Gupta, MD, 2226 Gillespie Neuroscience Research Facility, 837 Health Science Rd., Irvine, CA 92697; e-mail: [email protected]
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
