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Content validity addresses the question, “Does the simulation measure the relevant dimensions of the task under study? ” Content validity is often assessed with a thorough search of the literature and by interviewing expert surgeons. Face and content validity are subjective and arguably not as rigorous as some other assessments of a simulator’s validity. Physical and virtual reality surgical simulators, alone or in tandem, have proven themselves as viable training platforms. Physical simulators range in sophistication from low-fidelity representations of a prescribed task, such as laparoscopic suturing, to very realistic, instrumented mannequins. These are designed to teach a solitary task in a procedure through repetition. These are designed to replicate the entire scope of a complex scenario, such as a surgical procedure.
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Current assessment and future directions of surgical skills laboratories. Karam MD, Westerlind B, Anderson DD, Marsh JL. Development of an orthopaedic surgical skills curriculum for post-graduate year one resident learners — The University of Iowa experience.
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Skill transfer is much more closely tied to psychological fidelity than to physical fidelity. A simulator’s psychological fidelity with a task is more difficult to assess than its physical fidelity. The designer must distill the essential task elements that must be supported in the simulated environment.
In many other cases, higher physical fidelity simulators produce little to no quantifiable benefit in training over lower physical fidelity simulators38-39. The degree of verisimilitude affects the cost, time, complexity, and technology required in development. The current trend in simulation is to strive towards building the highest fidelity simulator possible. Unfortunately, in trying to mimic Spider-man for Windows minute details, these ultra-realistic simulators occasionally include irrelevant tasks. Construct validity defines the extent to which the simulator measures the specific trait or traits that it was designed to measure. Many construct validity studies demonstrate that different learner skill levels are associated with variations in the measurements made by the simulator. Demonstrating a significant difference in expert and novice scores demonstrates that the simulator correctly identifies quantifiable aspects of surgical skill.
If the correct elements are distilled, training on a simulator will transfer to the real task environment. The complement to physical fidelity is psychological fidelity.
Research should provide a greater emphasis on validity studies that go beyond establishing simple face validity. They should specify and, ideally, benchmark the performance of simulator elements designed to replicate critical tasks and they should design performance measures that can be tied back to the task model. Simulation has a great potential to facilitate faster and more effective learning in orthopaedic surgery. In order to capture the benefits of this training, it is important that researchers and practitioners organize their efforts to gain the maximum advantage in the shortest time with the least cost. This summary of research reveals a number of opportunities for growth in the future of orthopaedic surgery simulation. Skill transfer from the simulator to real scenarios should be the pinnacle of all training simulator development goals.