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SIMULATION-BASED TRAINING FOR ORTHOPEDIC RESIDENTS: IMPACT ON
SURGICAL CONFIDENCE AND SKILL ACQUISITION
Mukhammadiyev Sobirjon Uchkunjon ugli
Traumatology and Orthopedics, FMIOPH, Fergana, Uzbekistan
mukhammadiyev95@gmail.com
Nishanov Eshonkhoja Khamedkhoja ugli
Traumatology and Orthopedics, FMIOPH, Fergana, Uzbekistan
eshonxojanishonov@gmail.com
Eminov Ravshanjon Ikromjon Ugli
Faculty and Hospital Surgery Department, FMIOPH, Fergana, Uzbekistan
Abstract:
Simulation-based training has revolutionized orthopedic education by providing
realistic, risk-free environments for surgical practice. This article reviews current technologies
such as Virtual Reality (VR), Augmented Reality (AR), Mixed Reality (MR), and haptic-based
systems used to train orthopedic residents. These tools improve psychomotor skills, surgical
confidence, and procedural accuracy. Despite rapid technological advancement, challenges
such as cost and curricular integration remain. Structured simulation programs hold promise for
the future of surgical education.
Keywords:
simulation, orthopedics, training, technology, surgery
Аннотация:
Обучение на основе симуляторов произвело революцию в ортопедическом
образовании, обеспечивая реалистичную и безопасную среду для практики
хирургических навыков. В статье рассматриваются современные технологии, такие как
виртуальная реальность (VR), дополненная реальность (AR), смешанная реальность (MR)
и системы с тактильной обратной связью, используемые в подготовке ортопедов. Эти
технологии улучшают психомоторные навыки, уверенность хирургов и точность
операций. Несмотря на достижения, остаются проблемы интеграции в учебные
программы и высокая стоимость. Структурированные симуляционные курсы имеют
большое будущее в хирургическом обучении.
Ключевые слова:
симуляция, ортопедия, обучение, технологии, хирургия
Annotatsiya:
Simulyatsiyaga asoslangan treninglar ortopediya taʼlimida inqilobiy o‘zgarishlar
olib keldi. Ular jarrohlik amaliyotini xavfsiz va real muhitda mashq qilish imkonini beradi.
Ushbu maqolada ortopediya rezidentlarini o‘qitishda qo‘llaniladigan Virtual Haqiqat (VR),
Kengaytirilgan Haqiqat (AR), Aralash Haqiqat (MR) va haptik tizimlar haqida so‘z boradi. Bu
texnologiyalar psixomotor ko‘nikmalar, jarrohlik ishonchi va aniqligini oshiradi. Ammo yuqori
xarajatlar va o‘quv dasturlariga to‘liq integratsiya kabi muammolar mavjud. Tuzilgan
simulyatsiya dasturlari kelajakda jarrohlik taʼlimining ajralmas qismiga aylanishi kutilmoqda.
Kalit so‘zlar:
simulyatsiya, ortopediya, taʼlim, texnologiya, jarrohlik
Introduction
Simulation-based training for orthopedic residents employs a variety of simulators and
technologies, each offering unique advantages and addressing different aspects of surgical
education. Virtual Reality (VR) and Mixed Reality (MR) environments are prominently used,
leveraging platforms like HTC Vive™ and Microsoft HoloLens™ to create immersive training
experiences. These technologies allow residents to practice procedures such as the Less
Invasive Stabilization System (LISS) plating surgery and Condylar plating surgery, which are
crucial for treating femur fractures[1] [2] [3]. The integration of haptic feedback in simulators
further enhances the realism by providing tactile sensations, which are essential for developing
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the psychomotor skills necessary for orthopedic surgery[2] [9]. Additionally, the use of green
screen technology in MR environments enables interaction with both virtual and real-world
objects, offering a comprehensive training experience[1] [3]. The Internet of Medical Things
(IoMT) and Next Generation Internet technologies facilitate the development of network-based
simulators, allowing for distributed and collaborative training environments that are accessible
24/7[3] [10]. Despite the technological advancements, the focus of many studies remains on
validating these simulators rather than integrating them into formal curricula, highlighting a
need for curricular development that aligns with educational frameworks like Kern's[4].
Moreover, the use of physical simulators, such as cadavers and models, continues to play a role,
particularly in arthroscopy training, where hybrid simulators combine VR with physical
components to provide realistic tactile feedback[7]. The evolution of orthopedic training
methodologies, including the use of low-cost modules and motion tracking, reflects a shift
towards more accessible and standardized training solutions[5] [6]. Overall, the diverse array of
simulators and technologies underscores the potential of simulation-based training to enhance
the surgical skills of orthopedic residents, although further integration into structured
educational programs is necessary to maximize their impact[8].
Virtual Reality (VR) Simulators
Virtual Reality (VR) simulators are among the most widely used tools in orthopedic training.
These systems provide an immersive environment where residents can practice surgical
procedures without the risk of patient harm. VR simulators are further categorized into two
types:
a. Desktop VR Simulators
Description: These are non-immersive systems that use a computer, video screen, and a
joint model. They allow residents to practice using various instruments and provide haptic
feedback. Innovative software enables multiple training programs, offering precise
performance feedback [1] [2].
Example: The ARTHRO Mentor (Symbionix) and ArthroS (VirtaMed) are examples of
desktop VR simulators used for arthroscopic training [14].
b. Immersive VR Simulators
Description: These systems use head-mounted displays (HMDs) to create a fully
immersive environment. They are particularly effective for complex procedures like hip
arthroscopy and total hip arthroplasty. Studies have shown that skills learned on immersive VR
simulators can be successfully transferred to real clinical scenarios [3] [9].
Example: The PrecisionOS simulator is an immersive VR system used for training in
hip arthroscopy [3].
Augmented Reality (AR) and Mixed Reality (MR) Simulators
Augmented Reality (AR) and Mixed Reality (MR) technologies are gaining traction in
orthopedic training. These systems combine virtual and real-world elements to enhance surgical
planning and education.
a. Augmented Reality (AR)
Description: AR overlays digital information onto the real world, enabling surgeons to
visualize patient-specific anatomy in real-time. This technology is particularly useful for
preoperative planning and intraoperative navigation [5] [6].
Example: Microsoft HoloLens is used to create hybrid simulators for orthopedic open
surgery, combining AR with physical models [15].
b. Mixed Reality (MR)
Description: MR allows interaction between virtual and real-world objects in real time.
It is often used in hybrid simulators to create a more dynamic training environment [16] [18].
Example: A mixed-reality simulator for Condylar plating surgery uses greenscreen
technology to merge virtual and physical elements [16].
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Hybrid Simulators
Hybrid simulators combine physical models with virtual or augmented reality elements to
create a more realistic training experience.
Description: These systems use patient-specific anatomical models created from
imaging data (e.g., CT scans) and integrate them with virtual content. They are particularly
useful for procedures like hip arthroplasty [15].
Example: The Microsoft HoloLens-based hybrid simulator for hip arthroplasty
combines physical synthetic bones with virtual anatomical models [15].
4. Physical and Synthetic Simulators
Physical and synthetic simulators are non-digital tools that replicate real-world surgical
environments. They are often used in conjunction with virtual technologies.
Description: These simulators use synthetic bones or cadaveric models to mimic
surgical scenarios. They are ideal for training in procedures like thoracolumbar pedicle screw
placement and knee arthroplasty [11] [12].
Example: Synthetic spine models are used in simulation training for spinal
instrumentation placement [11].
Digital Twins and Surgical Digital Twins (SDTs)
Digital twins are virtual replicas of real-world objects or environments. In orthopedic training,
they are used to create high-fidelity surgical environments for preoperative planning and
simulation.
Description: Surgical Digital Twins (SDTs) are dynamic 3D models that replicate the
entire surgical scene, including anatomy, instruments, and the surgeon's movements. They are
integrated with VR systems like SurgTwinVR for immersive training [4].
Example: SurgTwinVR is a VR application that immerses users in an SDT for surgical
education [4].
Haptic-Based Simulators
Haptic-based simulators focus on providing tactile feedback, which is essential for mastering
surgical techniques.
Description: These systems use haptic devices to simulate the feel of surgical
instruments and tissues. They are particularly useful for training in minimally invasive
procedures like arthroscopy [3] [17].
Example: The haptic-based simulator for Less Invasive Stabilization System (LISS)
plating surgery provides realistic feedback for femur fracture repair [17].
Network-Based and Online Simulators
Advances in internet and networking technologies have enabled the development of online
simulators that can be accessed remotely.
Description: These systems allow residents to train anytime and anywhere, making
them ideal for standardized curriculum-based training. They often incorporate haptic feedback
and immersive environments [17] [20].
Example: A standalone online haptic-based simulator for LISS plating surgery is
accessible to residents via next-generation internet technologies [17].
Multi-Modality Educational Workshops
These workshops combine multiple simulation technologies and educational methods to
provide comprehensive training.
Description: They often include VR simulations, saw-bone models, tutorials, and case-
based discussions. These workshops are designed to improve understanding of surgical
principles and procedures [12].
Example: A multi-modality "Bootcamp" for total knee arthroplasty (TKA) training
includes VR simulation, saw-bone exercises, and case-based discussions [12].
Cyber-Human Frameworks
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These frameworks integrate virtual and physical systems to create advanced training
environments.
Description: They use information-centric systems engineering (ICSE) principles to
design simulators that combine haptic feedback, immersive VR, and real-time data analysis.
These systems are particularly useful for complex procedures like femur fracture
stabilization [20].
Example: A cyber-human framework for LISS plating surgery uses haptic-based and
immersive VR systems to train residents [20].
Table:
Comparison of key simulators and technologies
Conclusion
Simulation-based training in orthopedics has evolved significantly with the integration of
advanced technologies like VR, AR, MR, and digital twins. These tools provide residents with
a safe and efficient way to acquire and refine surgical skills. While VR and immersive
technologies dominate the field, hybrid and haptic-based systems are also gaining popularity.
Despite their benefits, challenges such as high costs, technical limitations, and the need for
further validation remain. As technology advances, these simulators are expected to play an
even greater role in shaping the future of orthopedic surgical training.
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