AO Milestones leverages DEHST technology to help redefine training of orthopedic residents

AO Milestones utilizes Digitally Enhanced Hands-on Skills Training (DEHST) platform—widely acclaimed by both AO Trauma faculty and orthopedic residents—that has now been officially validated by research published in two international journals, underscoring its significance in resident training.

Bringing together expertise from all three AO Institutes—the AO Research Institute Davos (ARI), the AO Innovation Translation Center, and the AO Education Institute—the novel DEHST skills training platform enhances practical exercises with digital technologies to create a comprehensive, interactive training experience that efficiently translates theoretical knowledge into practical surgical skills.
Employing a miniaturized model of an intraoperative image intensifier (C-arm) with an artificial x-ray imaging engine generating radiation-free, simulated x-rays, DEHST enables an enhanced training spectrum and a new kind of user experience. Additionally, DEHST customizes each training session to match a resident’s skill level, significantly enhancing technical proficiency and critical thinking. These qualities make it an ideal component of AO Milestones, the AO Trauma program redefining orthopedic residency training by integrating modern technology with the cornerstones of traditional medical education.

‘Significantly enhanced performance’

In a study published by Pastor et al in 2024, DEHST was put to the test in a mock operational setting involving 20 first-year residents—all novices without surgical experience in freehand distal nail interlocking—randomly assigned to two groups to perform distal interlocking of a tibial nail. Participants in one group were trained with DEHST (five interlocking attempts, one hour of training) while those in the other group received no training. The two groups were compared in terms of time, number of x-ray shots, hole roundness in the x-ray projection, and hit rates. The study found that training with DEHST significantly improved the performance of novices in the distal interlocking of intramedullary nails, thus showing potential to enhance safety and efficiency of this challenging surgical procedure. This allows for a faster learning progression without endangering patients.

In an earlier study (Pastor et al, 2022) the DEHST system was evaluated and yielded high scores in terms of training capability and realism. Additional, construct validity was established, as the system reliably discriminates between expert and novice users. The study concluded that all participants saw high overall training potential for DEHST because the system—in addition to intramedullary nailing—is easily adaptable to other core surgical tasks.

High praise from faculty and learners

Besides these research studies, the DEHST platform has been put through its paces in educational events. At AO Trauma North America’s recent basic and advanced principles courses in Toronto, Canada, both faculty and residents tested the platform.

“For our basic [principals] course, it would be a great addition,” said AO Trauma faculty member Stephen Sims .

Faculty member Geoff Wilkin, MD, FRCCSC, called DEHST “a good exercise, especially for junior residents, that allows them to change view and position of the C-arm.”

Faculty member Jennifer Bruggers, MD, said the system addresses an existing issue in terms of safe teaching and lauded its ability to assess learners’ performance.

“The visual assessment and metrics to get better feedback of how you are performing the task helps us better educate,” she said.

Another faculty member, Carla Smith, MD, PhD, described DEHST as a “very low-risk way to establish key components of a surgical procedure.”

“It provides a risk-free learning environment to really underscore the principle and practice the general proficiency,” she explained.

Residents who had a chance to try DEHST praised its accuracy, its usefulness in practicing surgical tasks that aren’t typically taught or practiced outside of the operating room (OR), and its tactile feedback.

“The x-ray is so accurate and looks like what we have in the OR; DEHST is easy to implement because it is real ,” said Jaqi Kakalecik, a fourth-year resident at the University of Florida.

Designed to meet the rigorous standards established by the Accreditation Council for Graduate Medical Education (ACGME), AO Milestones ensuring orthopedic residents are well-prepared for the demands of today's rapidly evolving medical field. Designed with residency program directors, orthopedic residents, and medical faculty in mind, the program represents the next generation of trauma surgery education. In addition to DEHST, AO Milestones’ suite of features includes:

• Adaptive learning modules: A cutting-edge adaptive learning system dynamically adjusts educational content based on real-time assessments of learner progress and needs. 
  
  
• Comprehensive assessments: In-depth formative and summative evaluations that simulate real-world medical scenarios, allowing residents and program directors to continually assess and enhance learning outcomes.