Simulation-based training in orthopedic surgery: A systematic review
Charlie J. Woodward, Omeair Khan, Abdüllatif Aydın, Prokar Dasgupta, Joydeep Sinha
Abstract
The wider adoption of simulation within orthopaedic training has led to the development of various orthopaedic models and simulators. The aim of this systematic review was to identify all validated orthopaedic simulation models, evaluate the strength of each validity parameter and determine the simulators’ translational value. A systematic search was performed on PubMed and Embase databases for studies published from inception to 20/10/2023. Studies were analysed according to training modality and the type of procedure. The educational value of each study was assessed using Messick's (1995) modern concept of validity framework using 5 parameters: content validity, response process, internal structure, relation to other variables and consequences. These were quantified using Beckman's (2005) rating scale. McGaghie's (2014) translational outcomes were applied to evaluate the Level of Effectiveness (LoE) of each study. 110 studies evaluating 94 orthopaedic simulators/models were identified, either validating or assessing the translational outcome of the simulator. 18 studies achieved the highest rating for content validity, 34 for response process, 16 for internal structure, 37 for relations to other variables and one for consequences. Three simulators demonstrated a LoE of 3, showing skill transfer within a clinical context. With the introduction of working hours restrictions and a greater emphasis on patient safety, the demand for validated orthopaedic simulators is increasing. Further studies adopting modern validation criteria and the inclusion of non-technical skills training is recommended.