Effectiveness of skin traction and skeletal traction simulating modules

Abstract

Background: Lower extremity immobilization by skin and skeletal traction are fundamental skills for medical students (MS). An increasing number of MS in training preclude them from a hand-on direct experience with patients. A skin and skeletal traction-simulating module for lower extremity thus developed and included in the orthopaedic curriculum.

Objective: To assess the effectiveness of the developed skin and skeletal traction-simulating module in teaching MS skill.

Methods: During the 2016 - 2018 study period, 16 groups of students (420 MS), were enrolled into a randomized controlled study. Each group rotates in orthopaedic department for 2 weeks. The groups were random into either controlled or module group of skin or skeletal traction. One hundred and two MS were trained with the skin traction module (group M1) using the standardized protocol while 106 MS served as a control (group C1), and 107 MS trained with skeletal traction module protocol (M2) while 105 MS are control for skeletal traction (C2). Outcomes were assessed by Objective Structured Assessment of Technical Skills scores (OSATS) and Modified Global Rating Scale (MGRS) at the end of the rotation.

Results: For skin traction, the average scores of M1 and C1 were 17.2 ± 2.4 vs. 16.5 ± 3.1 (mean difference 0.7, 95% CI – 0.1 to 1.4, P= 0.08) for OSATS and 30.8 ± 5.6 vs.18.8 ± 4.20 (mean difference 12, 95% CI 10.7 to 13.3, P < 0.0001) for MGRS scores, respectively. For skeletal traction, the average scores of M2 and C2 were 18.8 ± 2.1 vs. 12.1 ± 3.8 (mean difference 6.7, 95% CI 5.9 to 7.5, P < 0.0001) for OSATS and 33.3 ± 5.5 vs. 17.6 ± 4.2 (mean difference 15.7, 95% CI 14.4 to 17.0, P < 0.0001) for MGRS scores, respectively.

Conclusion: The developed skin and skeletal traction simulating modules is effective in imparting the skill to the trainee. It should be included to the orthopaedic rotation. Similar models might be broadened to other fields of orthopaedic teaching.