Simulation-Based Training of Surgical and Nonsurgical Skills in Orthopaedic Residency (Symposium Presented at the 2024 Summer CORD Conference).

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.