Educational impact of a structured simulation-based orthopedic training program on technical and non-technical competency development: a prospective pre-post study

Abstract

Contemporary orthopedic education faces reduced clinical exposure, increasing procedural complexity, and growing emphasis on patient safety. Simulation-based learning (SBL) offers a structured alternative to traditional apprenticeship models, enabling deliberate practice and competency-based assessment. This study evaluated the educational impact of a structured, hands-on, simulation-based orthopedic workshop on the development of technical and non-technical competencies among medical students. We conducted a prospective pre-post interventional study including 70 medical students across all 6 years of training. Participants completed pre- and post-intervention assessments evaluating self-confidence in musculoskeletal trauma management, perceived technical skills, non-technical competencies (communication, teamwork, situational awareness), motivation toward orthopedics, and theoretical knowledge through a 10-item multiple-choice questionnaire. Statistical analysis employed non-parametric testing (Wilcoxon signed-rank, Mann-Whitney U, Kruskal-Wallis). Effect sizes were calculated using r = Z/√N, with values > 0.5 indicating large effects. Internal reliability was assessed using Cronbach's alpha. Significant improvements were observed across all evaluated domains (all P < 0.001), with large effect sizes (r > 0.5). Confidence in musculoskeletal trauma management demonstrated the greatest increase (median 4 pre-workshop vs. 9 post-workshop). Theoretical knowledge improved in most domains. Internal consistency of the assessment instrument was excellent (Cronbach's alpha 0.896-0.961). Senior students demonstrated higher baseline and post-intervention scores compared to junior cohorts (P < 0.05). No significant gender-based differences were identified, except in procedural risk recognition (P < 0.001). Participation in a structured simulation-based orthopedic workshop was associated with meaningful multidimensional educational gains, including enhanced perceived technical competence, strengthened non-technical skills, increased confidence, and improved knowledge acquisition.

Keywords: medical students; non-technical skills; pre-post educational intervention; simulation-based learning; surgical skills training; technical skills acquisition.