title: Simulation training: a systematic review of simulation in arthroscopy and proposal of a new competency-based training framework.
abstract: BACKGROUND
  Traditional 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.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  A 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".
  
  
  RESULTS
  14 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Surgery and Cancer/Musculoskeletal Laboratory, Imperial College London, Charing Cross Hospital, MSk Lab, 7th Floor, Lab Block, London W6 8RF, UK. Electronic address: charison.tay09@imperial.ac.uk.
authors.forename: Charison
authors.initials: C
authors.lastname: Tay
authors.affiliation: Department of Surgery and Cancer/Musculoskeletal Laboratory, Imperial College London, Charing Cross Hospital, MSk Lab, 7th Floor, Lab Block, London W6 8RF, UK.
authors.forename: Ankur
authors.initials: A
authors.lastname: Khajuria
authors.affiliation: Department of Surgery and Cancer/Musculoskeletal Laboratory, Imperial College London, Charing Cross Hospital, MSk Lab, 7th Floor, Lab Block, London W6 8RF, UK; North West London Deanery Higher Surgical Rotation in Orthopaedics, UK.
authors.forename: Chinmay
authors.initials: C
authors.lastname: Gupte
mesh_terms: D001182:Arthroscopy / Q000193:education* / Q000592:standards; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D009985:Orthopedics / Q000193:education; D016544:Patient Simulation
keywords: Arthroscopy; Simulation; Training; Validity; Virtual reality