The main findings of this study indicate that participation in AOT ORP courses had a significant and consistent impact on improving the practical skills level of ORPs from three different countries. This improvement was evident in both the overall performance and in each individual skill assessed using our newly introduced research tool.
When comparing the study group to itself before and after the course, we observed that the third task (lateral malleolus fixation) received the highest evaluation score. However, it is important to note that the second task, which initially scored the lowest, demonstrated the greatest improvement following the course. This suggests that participants had more to gain from the course in tasks where they initially scored lower. Notably, the fifth task, which also had a relatively low score before the course, showed the second highest level of progress, further supporting this assumption.
These findings suggest that the AOT ORP course was effective in enhancing participants' skills across a range of tasks, with a particular emphasis on tasks where they initially had lower proficiency. The results highlight the impact of the training program and its ability to address specific areas of improvement.
Our results reveal a significant distinction between participants from Israel and those from England and Singapore. Specifically, participants from Israel demonstrated a greater overall improvement after completing the course compared to participants from the other countries. Possible explanation for this difference is that participants from the Israel subgroup initially scored lower in 3 out of 5 tasks compared to the participants from the other groups due to language barrier. Consequently, they may have had more room for improvement and benefited more from face-to-face course. This explanation aligns with our previous interpretation of the task that initially received the lowest scores, further supporting our claim regarding the acquisition of practical skills.
Furthermore, the comparatively higher pre-course scores of participants from Singapore and UK may indicate the advantages that the teaching material is in the mother tongue and without the need to use translation as in the case of Israel. Conversely, participants from Israel might have been more inclined and open-minded towards embracing the correct practices conveyed by the course.
These findings highlight the influence of participants' initial skill levels and training backgrounds on their response to the course. They also underscore the importance of considering cultural and contextual factors when designing training programs and assessing their effectiveness
In Israel, AOT basic principles courses have recently become a mandatory requirement for orthopedic residency programs. These courses are designed to systematically develop surgeons' clinical skills in preparation for practical surgery procedures. Following the Miller pyramid of learning model22, surgeons progress from acquiring knowledge about "what to do" to demonstrating the procedure and receiving feedback from guidance staff. They then gain the qualification to perform surgery independently. The pinnacle of the pyramid is reached when surgeons perform the procedure on real patients using the tools acquired during the course. Our findings support the effectiveness of this theory, as demonstrated by the improvement in each of the measured practical skills and have been performed by ORPs.
The study findings are further supported by Kolb's study on the experiential learning cycle23. Kolb observed that meaningful learning occurs through a cognitive process involving acquiring new knowledge, transforming it into practical experience through reflective observation, perception construction, and implementation. This experiential learning cycle helped participants in the AOT ORP course to bridge the gap between theory and practical skills. Repetition of the practical skills led to improved performance, this platform from the course can further assist ORPs acquire tools and optimally integrate them into their clinical practice.
Additionally, Ryder et al.'s study investigated the influence of continuing professional development (CPD) among graduated nurses in an Irish academic hospital. The study found that practice-based learning, particularly in clinical areas, was reported to be excellent, while classroom-based theoretical lectures were perceived as exhausting24. This underscores how hands-on practical learning enhances skill development.
Practical training of nursing operating room staff is crucial, such as training in the AOT ORP course as an additional layer for training dedicated ORP in an orthopedic OR setting. In a study at a tertiary medical center, designated staff in the orthopedic operating room showed significant benefits, including shorter surgery and hospitalization durations, reduced rates of re-hospitalizations, infections, and revision surgeries25. Another study on spine surgery found that having a high percentage of designated nurses improved treatment outcomes, resulting in shorter operating times, decreased blood loss, and shorter turnover times between cases26.
The primary limitation of our study was the exclusive use of a control group from Israel, potentially introducing bias from variations in pre-course scores between countries, groups and pre course eLearning assessments. However, despite this limitation, we were able to quantify the improvement in practical performance. Through the comparison of pre-course and post-course results among the study group consisting of different countries with diverse cultural backgrounds and training, as well as comparing to control group with no preparation of eLearning assessments. we aimed to identify variations in the influence and implementation of the AOT ORP course among operating room nurses.
Empirical tests with predefined criteria and estimation forms facilitated evaluation of the practical test. Our study's robust findings underscore the positive impact of the AOT ORP course on nursing staff's clinical performance in orthopedic operating rooms, consistently observed across different countries.