Enhancing orthopaedic competency through simulation: A student-centered approach to bridge educational gaps

Table 1 Baseline characteristics of study participants (n = 106)

Variable	Category	Frequency (n)	Percentage (%)
Age (years)	mean ± SD	22.6 ± 1.1	-
Gender	Male	54	50.9
	Female	52	49.1
Prior simulation exposure	Yes	22	20.7
	No	84	79.3
Academic performance (last exam)	≥ 75%	44	41.5
	< 75%	62	58.5

SD: Standard deviation.

Table 2 Comparison of pre-simulation and post-simulation outcomes (n = 106)

Parameter	Presimulation (mean ± SD)	Post-simulation (mean ± SD)	Mean difference	P value1
Procedural accuracy score (%)	62.5 ± 10.3	84.9 ± 8.6	22.4	< 0.001
Knowledge test score (%)	63.4 ± 11.2	78.2 ± 9.4	14.8	< 0.001
Confidence level (0-10 scale)	4.6 ± 1.7	8.2 ± 1.1	3.6	< 0.001

¹Paired t-test.

SD: Standard deviation.

Table 3 Confidence levels before and after simulation (n = 106)

Confidence level	Pre-simulation	Post-simulation	P value1
Low (1-3)	34 (32.1)	4 (3.8)	< 0.001
Moderate (4-6)	51 (48.1)	37 (34.9)
High (7-10)	21 (19.8)	65 (61.3)

Data are presented as n (%).

¹χ² test.

Table 4 Association between prior simulation exposure and post-simulation procedural accuracy (n = 106)

Exposure		Accuracy ≥ 85%	Accuracy < 85%	Total	χ² value	P value
Prior exposure	Yes	20	2	22	7.24	0.007
	No	42	42	84

Table 5 Predictors of high procedural accuracy (≥ 85%): Unadjusted odds ratio (n = 106)

Variable	Odds ratio (95%CI)	P value
Male gender	1.02 (0.49–2.15)	0.958
Prior simulation exposure	10.00 (2.10–47.60)	0.004
Academic score ≥ 75%	2.58 (1.20–5.56)	0.015

CI: Confidence interval.

Table 6 Multivariate logistic regression: Adjusted odds ratios for high procedural accuracy (≥ 85%) (n = 106)

Variable	Adjusted odds ratio (95%CI)	P value
Male gender	0.97 (0.43–2.18)	0.940
Prior simulation exposure	4.35 (1.26–15.02)	0.020
Academic score ≥ 75%	2.89 (1.08–7.71)	0.033

CI: Confidence interval.

Table 7 Comparison of current study with selected simulation-based orthopedic education studies

Ref.	Study design	Participants	Simulation modality	Outcomes measured	Key findings
Kelly et al[24], 2017	Mixed-methods study	Medical students	Simulated musculoskeletal environment	Knowledge, confidence, feedback	Improved self-efficacy and musculoskeletal exam skills
Butler et al[20], 2017	Pre-post intervention	Interns and students	Supracondylar fracture simulator	Technical skill, self-confidence	Improved skill performance and confidence post-training
Wilson et al[22], 2020	Randomized crossover trial	Undergraduate medical students	VR and physical models	Knowledge scores, retention	Both modalities improved scores; VR had slightly higher retention
Klingebiel et al[21], 2024	Experimental study	Orthopedic surgeons	Pelvic fracture simulator	Technical confidence, skill acquisition	Simulator enhanced emergency procedure readiness
Schöbel et al[23], 2024	Prospective controlled trial	Medical students	Immersive VR for knee arthroscopy	Procedural steps understanding, engagement	VR significantly improved procedural knowledge and engagement
Our study, 2025	Cross-sectional observational	106 final-year MBBS students	Synthetic bone models, plaster kits	Procedural accuracy, knowledge retention, confidence	Significant improvements in all domains; prior exposure and academic scores were predictors of better outcomes

VR: Virtual reality; MBBS: Bachelor of Medicine and Bachelor of Surgery.