Matthew D. Karam, MD; Robert A. Pedowitz, MD, PhD; Hazel Natividad, MA

Jayson Murray, MA; J. Lawrence Marsh, MD

Abstract
Background:  
Acquisition of surgical skills through laboratory-based training and simulation is appealing to surgical training programs. The purpose of this study was to provide baseline information on the current use of surgical skills training laboratories in orthopaedic resident education and to determine the interest in expansion of these facilities and training techniques.

Methods:  
The creation of the survey was a collaborative effort between the authors and the American Academy of Orthopaedic Surgeons (AAOS). Two online versions of the Surgical Skills Simulation survey were created, one (with twenty-three items) specifically for program directors and one (with fourteen items) for orthopaedic residents. The survey was sent via e-mail to 185 program directors and 4549 residents. Data were retrieved and analyzed by the AAOS Department of Research and Scientific Affairs.

Results:  
Eighty-six (46%) of the 185 surveys distributed to orthopaedic surgery residency directors and 687 (15%) of the 4549 distributed to orthopaedic surgery residents were completed. Seventy-six percent of the program directors reported having a surgical skills laboratory, and 46% of these reported having a structured surgical skills laboratory curriculum. Fifty-eight percent of program directors and 83% of residents believed that surgical skill improvement by orthopaedic residents was not being objectively measured. Both 80% of program directors and 86% of residents agreed that surgical skills simulations should become a required part of training, and 82% and 76% were interested in a standardized surgical skills curriculum. Eighty-seven percent of program directors identified a lack of available funding as the most substantial barrier to development of a formal surgical skills program at their institution.

Conclusions:  
There was strong agreement among both program directors and residents that surgical skills laboratories and simulation technology should be a required component of orthopaedic resident training. At the present time, the most substantial barrier to adoption of surgical skills laboratories and a formalized surgical skills curriculum is the lack of funding.