Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice: 58. Validity of the Fundamental of Spinal Surgery (FOSS) simulator as a teaching tool for orthopedic and neurosurgical trainees

BACKGROUND CONTEXT While all surgical disciplines require years of study to acquire knowledge and experience, surgical trainees must also develop the necessary psychomotor skills to perform surgical procedures. To date, there are limited validated tools to objectively assess trainees as they progress through their education. Pedicle screw placement is a demanding surgical skill set to learn and teach as challenges such as variations in pedicle morphology and spinal deformities can be encountered.  Available CT simulators for pedicle placement can be costly and hands on cadaver courses are limited by specimen availability. PURPOSE We sought to develop a cost-effective training tool that could be used by all orthopedic and neurosurgical residencies. STUDY DESIGN/SETTING Multicenter study (four academic institutions). PATIENT SAMPLE Orthopedic and neurosurgery residents and spine attending surgeons are recruited. OUTCOME MEASURES Outcomes measures include the scores for all three tasks and the time taken to complete the tasks. METHODS After IRB approval, a low cost spine simulator ($30.00) was created to test three main skill sets all pertaining to the task of placing a pedicle screw: ability to find appropriate trajectory, ability to navigate down the isthmus of a pedicle, and ability to recognize wall penetrations. Residents as well as spine attending surgeons were recruited to participate from four different institutions. Each participant was given three tasks to complete. Task 1 entails creation of the pedicle screw path with a standard gearshift probe, with the number of “cortical breaks” being recorded.  Task 2 entails testing the ability to palpate for the presence or absence of wall defects. Task 3 is the ability to determine the location of wall defects. The number of correct answers for task 2 and 3 are recorded. RESULTS The ability to differentiate between surgical residents and master spine surgeons was obtained. In all tasks, spine attending surgeons scored higher than residents. Attending surgeons reported that FOSS simulator is a good tool which can be beneficial for training surgical residents in terms of tactile feedback and directionality of probe and pedicle placement. Moreover, the FOSS stimulator also allowed participants the ability to feel the difference between young cortical bone versus osteoporotic bone. Eighty-one percent of the spine attending surgeons reported that they would use this educational technology in the future for training purposes. Eighty-four percent of all residents, and 100% of PGY1 residents reported that they would use FOSS simulator for training. CONCLUSIONS Recent published work has demonstrated the role of low cost tools for teaching and testing psychomotor skills in orthopedic surgery. Here, we developed the next tool to be used for spine surgery. FOSS is an invaluable asset as it will allow surgical trainees to engage and enhance their visual, auditory and proprioceptive feedback safely during pedicle screw placement outside of the operating room. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.