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High-Fidelity Simulations for Orthopaedic ResidentsMedical Complications and Systems Challenges
Marjorie Lee White, MD, MPPM, MEd1; Shawn R. Gilbert, MD2; Amber Q. Youngblood, BSN, RN3; J. Lynn Zinkan, MPH, BSN, RN3; Rachel Martin, BS4; Nancy M. Tofil, MD, MEd5
1 Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, Birmingham, AL 35233
2 Division of Orthopaedic Surgery, Department of Surgery, University of Alabama at Birmingham, 1600 7th Avenue South, ACC 316, Birmingham, AL 35233. E-mail address: srgilbert@uabmc.edu
3 Children’s of Alabama, Nursing Education & Research, 1600 7th Avenue South, Harbor Building, Suite 140, Birmingham, AL 35233
4 University of Alabama at Birmingham Medical School, 2825 Southwood Trail, Bessemer, AL 35022
5 Department of Pediatrics, Pediatric Critical Care Medicine, University of Alabama at Birmingham, 1600 7th Avenue South, Birmingham, AL 35233
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Investigation performed at the University of Alabama at Birmingham and Children’s of Alabama, Birmingham, Alabama

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 May 15;95(10):e70 1-4. doi: 10.2106/JBJS.L.00761
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Surgical training requires acquisition of procedural skills as well as competency in medical management. Changes in training and practice patterns have decreased the operative and nonoperative experiences of trainees. With the introduction of new technologies, more complex procedures, and a host of external constraints, the doctrine of learning primarily through supervised patient-care experiences has been superseded by efforts to teach in nonclinical environments1. Increasingly, simulation is being used to help learners develop essential operative technical skills to compensate for the loss of experience that historically has been obtained through exposure to cases. Hip fixation, osteotomy and fusion, and arthroscopy are some of the orthopaedic procedures that are taught through simulation2-4. Despite the attempts to compensate for decreased opportunities for procedural competency training, to our knowledge no one has developed an alternate method to teach clinical skills needed by orthopaedic residents to manage patients in the postoperative period. Residents develop the ability to manage emergency medical situations through exposure to patient problems, just as motor memory is developed through repetitive performance of a procedure. Feedback from more experienced physicians is another important component of learning proper medical management of patients. Whereas operative skill is supervised, thereby providing opportunities for immediate feedback and improvement, postoperative care receives less scrutiny. The simulated setting is an ideal place to practice handling medical emergencies in a standardized manner. Simulation-based medical education is recognized as a method of boosting medical professional performance while enhancing patient safety5. It is being used at a rapidly expanding rate for training of health-care providers, including pediatrics, internal medicine, and anesthesia residents, and for medical students, but we believe that this is the first description of a simulation-based medical education course focusing on postoperative care by orthopaedic residents. Our hypothesis was that simulation-based medical education would be well received by orthopaedic residents and that they would feel better able to respond to pediatric orthopaedic postoperative complications, including accessing support systems.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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