Motion Graphic Training for Scrub Nurses in Hip Surgery

This is a pilot randomized controlled trial conducted at Valiasr Teaching Hospital, Arak University of Medical Sciences, Iran, from December 2024 to July 2025. The study is designed according to CONSORT guidelines for pilot and feasibility trials.

A total of 30 undergraduate operating room technology students in their 6th or 8th semester are randomly assigned to intervention (n=15) and control (n=15) groups using block randomization with a computer-generated random numbers table. Both groups receive routine clinical training from the same instructor at the beginning of the course. The intervention group additionally views a 15-minute motion graphic video demonstrating DHS surgical steps, which they can watch unlimited times during the 15-day internship period. The video content includes introduction of surgical instruments, anatomy review, surgical table setup, patient preparation and draping, and instrument delivery to the surgeon.

Students' performance as first scrub nurse is assessed twice: on the first day of internship (pre-test) and at the end of the 15-day internship (post-test) by a blinded independent evaluator using a validated 43-item checklist covering preoperative (13 items), intraoperative (24 items), and postoperative (6 items) phases. The checklist has been validated for content validity and reliability through expert review and pilot testing.

To prevent contamination, the control group is enrolled first, and intervention group students are asked not to discuss the educational video with others. The video will be provided to the control group after study completion for educational equity.

Data will be analyzed using paired and independent t-tests. Effect sizes will be calculated for between-group comparisons.

• Motion Graphic Video Training (Other): A 15-minute animated video demonstrating the steps of proximal femur fracture surgery using a dynamic hip screw (DHS). Content includes surgical instruments, anatomy review, table setup, patient draping, and instrument delivery to the surgeon.
• Routine Clinical Training (Other): Standard clinical training in the operating room including attendance, performing the scrub nurse role, and receiving direct feedback from the clinical instructor during the 15-day internship.

Primary outcomes

• Scrub Nurse Performance Score [Baseline (day 1) and day 15 (end of 15-day internship)]: Performance assessed using a validated 43-item researcher-made checklist covering preoperative (13 items), intraoperative (24 items), and postoperative (6 items) phases. Each item is scored on a three-point scale: 0 = does not perform, 1 = performs incompletely, and 2 = performs correctly. The total score ranges from 0 to 86, with higher scores indicating better performance. The checklist was validated for content validity and reliability through expert review and pilot testing.
• Within-Group Pre-Post Score Changes [Baseline to day 15]: Comparison of Scrub Nurse Performance Scores (measured using a validated 43-item checklist, total score range: 0-86, with higher scores indicating better performance) before and after the 15-day internship within each group using paired t-tests.
• Between-Group Post-Test Score Comparison [Day 15]: Comparison of Scrub Nurse Performance Scores (measured using a validated 43-item checklist, total score range: 0-86, with higher scores indicating better performance) between the intervention and control groups after the 15-day internship using independent t-tests.

Sex: All, accepts healthy volunteers

Inclusion Criteria:

Undergraduate operating room technology student in the 6th or 8th semester

* Completion of the theoretical course in orthopedic operating room technology and care
* Willingness to participate and provide informed consent

Exclusion Criteria:

Withdrawal or unwillingness to continue participation at any stage

* Previous clinical experience in orthopedics that could affect the results
* Absenteeism or insufficient presence during the internship

• Hamed parnikh, Principal investigator, Arak University of Medical Sciences