DOI: 10.1093/bjs/znad258.579 ISSN:

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

A Feeley, I Feeley, K Merghani, E Sheehan
  • Surgery



The aim of this study was to evaluate the impact of a surgical warm-up using a virtual reality simulator on operative performance.


This was a single-blinded cross-over randomised control trial in a single tertiary Orthopaedic training centre. Orthopaedic trainees were recruited, and each morning participants rostered to theatre were randomised 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 orthopaedic trainers were recruited within the orthopaedic unit to carry out subjective surgical performance assessments using a validated global rating scale tool on the first case the participant performed on 46 the list as primary operator.


Over 3 study periods a total of 151 datapoints were collected, with 49 matched datapoints across priming status and procedural level of difficulty. Subjective assessment tools consistently demonstrated improved operative performance by participants following surgical priming (p = 0.001).


This study highlights that introduction of preoperative priming to improve operative preparation and optimises 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.

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