Surgical Priming Improves Operative Performance in Surgical Trainees: A Crossover Randomized Control Trial

OBJECTIVE: The aim of this study was to evaluate the impact of a surgical warm-up using a virtual reality simulator on operative performance. DESIGN: This was a single-blinded cross-over randomized control trial in a single tertiary Orthopedic training center. PARTICIPANTS: Orthopedic trainees were recruited, and each morning participants rostered to theatre were randomized to either undergo a simulated surgical procedure on a virtual reality simulation system prior to their first case as primary operator (priming arm), or to perform their usual preparatory routine for surgery (control arm). Consultant orthopedic trainers were recruited within the orthopedic unit to carry out subjective surgical performance assessments using a validated global rating scale tool on the first case the participant performed on the list as primary operator. RESULTS: Over 3 study periods a total of 151 data points were collected, with 49 matched data points across priming status and procedural level of difficulty. Subjective assessment tools consistently demonstrated improved operative performance by participants following surgical priming (p = 0.001). CONCLUSION: This study highlights that introduction of preoperative priming to improve operative preparation, and optimizes operative performance. This has not only implications for improved resident training, but also signals towards beneficial downstream effects on patient outcomes, and theatre list planning.