Long Steven, Anderson Donald D, Nicandri Gregg, Gallo Robert A, Marsh J Lawrence, Karam Matthew
Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa.
Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, New York.
JB JS Open Access. 2025 Sep 8;10(3). doi: 10.2106/JBJS.OA.25.00109. eCollection 2025 Jul-Sep.
Modern orthopaedic residency training increasingly integrates knowledge, skills, and behavior (KSB), in line with updated American Board of Orthopaedic Surgery (ABOS) and Accreditation Council for Graduate Medical Education (ACGME) guidelines. Developments in simulation technology-including high-fidelity simulators, virtual reality, and data-driven assessment tools-enable programs to target both technical and non-technical competencies. This paper examines how innovations in simulation, curriculum design, and performance assessment are shaping the future of orthopaedic education.
This work synthesizes institutional practices, peer-reviewed literature, and consensus discussions from a 2024 Summer CORD Conference symposium to outline simulation-based training (SBT) and performance assessment strategies in orthopaedic residency.
A structured, PGY-level curriculum leverages a range of simulation tools-from low-fidelity models to virtual reality (VR)-to develop foundational and advanced technical skills. Programs like FAST and CROWNS, supported by data-driven feedback, improve arthroscopy and wire navigation proficiency without patient risk. Traditional cadaveric and sawbones training further reinforces skills in realistic settings. Objective and subjective assessments, such as procedure time, fluoroscopy use, OSATS, and the ABOS-mandated OP Score, offer complementary insight into resident progression. Benchmark testing, as seen in the University of Iowa's CROWNS program, may enhance competency before affording clinical autonomy. Non-surgical (clinical) skill is enhanced through assessment exercises like OSCEs, 360 evaluations, and video assessments. These tools assess communication, professionalism, and decision-making in reproducible, structured scenarios. OSCEs offer real-time feedback in simulated patient interactions, while video review promotes resident self-reflection and faculty-guided learning.
Despite challenges-particularly cost, faculty time, and integration of advanced technologies-simulation-based and competency-driven training models demonstrate potential to reduce reliance on live cases for skill acquisition, improve patient safety, and provide a framework for resident evaluation. Aligning simulation, assessment, and educational innovation prepares orthopaedic residents to meet the demands of surgical practice with technical excellence and sound clinical judgment.
根据美国骨科医师学会（ABOS）和毕业后医学教育认证委员会（ACGME）的最新指南，现代骨科住院医师培训越来越注重整合知识、技能和行为（KSB）。模拟技术的发展——包括高保真模拟器、虚拟现实和数据驱动的评估工具——使培训项目能够针对技术和非技术能力进行培养。本文探讨了模拟、课程设计和绩效评估方面的创新如何塑造骨科教育的未来。
本研究综合了机构实践、同行评审文献以及2024年夏季CORD会议专题研讨会上的共识讨论，以概述骨科住院医师培训中基于模拟的培训（SBT）和绩效评估策略。
一个结构化的、基于住院医师培训阶段（PGY）的课程利用了一系列模拟工具——从低保真模型到虚拟现实（VR）——来培养基础和高级技术技能。像FAST和CROWNS这样的数据驱动反馈支持的项目，在不涉及患者风险的情况下提高了关节镜检查和钢丝导航的熟练度。传统的尸体和实体模型训练在实际场景中进一步强化了技能。客观和主观评估，如手术时间、透视使用情况、OSATS以及ABOS规定的OP评分，为住院医师的进展提供了补充性见解。爱荷华大学的CROWNS项目中采用的基准测试，可能会在给予临床自主权之前提高能力水平。通过客观结构化临床考试（OSCE）、360度评估和视频评估等评估练习，非手术（临床）技能得到了提升。这些工具在可重复的、结构化的场景中评估沟通、专业素养和决策能力。OSCE在模拟患者互动中提供实时反馈，而视频回顾则促进住院医师的自我反思和教师指导下的学习。
尽管存在挑战——特别是成本、教师时间以及先进技术的整合——基于模拟和能力驱动的培训模式显示出减少对真实病例进行技能获取的依赖、提高患者安全性以及为住院医师评估提供框架的潜力。使模拟、评估和教育创新保持一致，有助于骨科住院医师以卓越的技术和合理的临床判断力满足外科实践的需求。
