The Journal of Bone and Joint Surgery (American). 2007;89:2819-2827.
doi:10.2106/JBJS.F.01502
© 2007 The Journal of Bone and Joint Surgery, Inc.
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The Effect of Computer Navigation on Trainee Learning of Surgical Skills

Wade Gofton, MD, MEd, FRCSC1, Adam Dubrowski, PhD2, Farshid Tabloie, MD3 and David Backstein, MD, MEd, FRCSC3

1 The Ottawa Hospital – Civic Campus, 1053 Carling Avenue, Suite 2178, Ottawa, ON K1Y 4E9, Canada. E-mail address: wgofton{at}ottawahospital.on.ca
2 Centre for Research in Education, 200 Elizabeth Street Eaton South 1E 583, Toronto, ON M5G 2C5, Canada. E-mail address: adam.dubrowski{at}utoronto.ca
3 Mount Sinai Hospital, 600 University Avenue, Suite 476(D), Toronto, ON M5G 1X5, Canada. E-mail address for F. Tabloie: tabloie{at}yahoo.com. E-mail address for D. Backstein: dbackstein{at}mtsinai.on.ca

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Royal College of Physicians and Surgeons of Canada – Education Fellowship. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: While computer-assisted orthopaedic surgery technology may facilitate performance and learning in the expert, its effects on the trainee are unclear. Motor learning theory suggests that, while the real-time feedback provided by computer-assisted orthopaedic surgery should improve performance, it may be detrimental to learning. The purpose of this study was to assess the effects of computer-assisted orthopaedic surgery on the learning of surgical skills by trainees.

Methods: Forty-five participants were randomized to one of three training groups—conventional training, computer navigation, or knowledge of results—in which they learned technical skills related to total hip replacement. Outcomes were assessed in a pretest session and in ten-minute and six-week retention and transfer tests.

Results: All groups demonstrated improved accuracy and precision in the determination of the abduction angle and the version angle of the acetabular cups during training (p < 0.001). The computer navigation group demonstrated significantly better accuracy and precision in early training (p < 0.05) and better precision throughout training (p < 0.05). No significant degradation in performance was observed between the immediate and the delayed testing for any group, suggesting that there was task learning in all groups with no negative effects of the tested training modalities on learning.

Conclusions: In this study, the concurrent augmented feedback provided by computer-assisted orthopaedic surgery resulted in improved early performance and equivalent learning. While we did not observe a compromise in learning, further investigation is required to ensure that computer-assisted orthopaedic surgery does not compromise trainee learning in more complex tasks.

Clinical Relevance: As the utilization of computer-assisted orthopaedic surgery techniques increases, it is essential that we develop an understanding of its effects on performance and learning in both the primary and continuing education environments.


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