title: Current Status of Simulation-based Training Tools in Orthopedic Surgery: A Systematic Review.
abstract: OBJECTIVE
  To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence (LoE) and level of recommendation.
  
  
  METHODS
  Medline and EMBASE library databases were searched for English language articles published between 1980 and 2016, describing orthopedic simulators or validation studies of these models. All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education.
  
  
  RESULTS
  A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study. The most commonly identified models (n = 34) and validation studies (n = 26) were for knee arthroscopy. Construct validation was the most frequent validation study attempted by authors. In all, 62% (47 of 76) of the simulator studies described arthroscopy simulators, which also contained validation studies with the highest LoE.
  
  
  CONCLUSIONS
  Orthopedic simulators are increasingly being subjected to validation studies, although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators.
authors.affiliation: School of Medicine, King's College London, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Morgan
authors.affiliation: MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom. Electronic address: abdullatif.aydin@kcl.ac.uk.
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Aydin
authors.affiliation: Department of Orthopedic Surgery, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Salih
authors.affiliation: Department of Orthopedic Surgery, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom.
authors.forename: Shibby
authors.initials: S
authors.lastname: Robati
authors.affiliation: MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
mesh_terms: D001182:Arthroscopy / Q000193:education; D002983:Clinical Competence; D006801:Humans; D009985:Orthopedics / Q000193:education*; D000066908:Simulation Training / Q000379:methods*
keywords: Interpersonal and Communication Skills; Patient Care; Practice-Based Learning and Improvement; orthopedic surgery; simulation; systematic review; training