Simulation training: A systematic review of simulation in arthroscopy and proposal of a new competency-based training framework

•We introduce a new training framework for simulation in orthopaedic education.•Implementation will require a process of approval, assessment and feedback.•Challenges include costs, adequate facilities and qualified staff to run them.•Successful implementation requires coordination between different organisations.

IntroductionTraditional orthopaedic training has followed an apprenticeship model whereby trainees enhance their skills by operating under guidance. However the introduction of limitations on training hours and shorter training programmes mean that alternative training strategies are required.AimsTo perform a literature review on simulation training in arthroscopy and devise a framework that structures different simulation techniques that could be used in arthroscopic training.MethodsA systematic search of Medline, Embase, Google Scholar and the Cochrane Databases were performed. Search terms included “virtual reality OR simulator OR simulation” and “arthroscopy OR arthroscopic”.Results14 studies evaluating simulators in knee, shoulder and hip arthroplasty were included. The majority of the studies demonstrated construct and transference validity but only one showed concurrent validity. More studies are required to assess its potential as a training and assessment tool, skills transference between simulators and to determine the extent of skills decay from prolonged delays in training. We also devised a “ladder of arthroscopic simulation” that provides a competency-based framework to implement different simulation strategies.ConclusionThe incorporation of simulation into an orthopaedic curriculum will depend on a coordinated approach between many bodies. But the successful integration of simulators in other areas of surgery supports a possible role for simulation in advancing orthopaedic education.