A mixed methods systematic review: Does computer-based simulation (CBS) in fracture surgery leads to better knowledge, skills and competencies than traditional preparation?

Objectives: To identify original research studies comparing CBS to traditional surgical preparation for fracture surgery and to analyse and synthesise the results to support the hypothesis that CBS is better than traditional methods in preparation for fracture surgery. Methods: Four databases 'Web of Science', 'Embase', 'Medline' and 'OrthoSearch' were searched using the terms 'orthopaedic', 'fracture', 'simulation' and 'education'. Two relevant journals, two conferences and two registries were hand searched. All searches were between Jan 2010 and April 2022. Selected articles underwent a backwards and forwards citation search. 1,285 articles were identified and screened for selection. Two reviewers independently extracted outcome data and completed a risk of bias analysis. Selected studies were included in a direction of effect synthesis and appropriate studies were included in a meta-analysis. Results: 15 studies totalling 350 participants, measuring the development of participants' knowledge, skills, and competencies, were included for direction of effect analysis. 86% (13/15) favoured CBS over traditional preparation. A meta-analysis of 4 studies, totalling 62 participants, measuring OSATS score favoured CBS, Standard Mean Difference = 1.06 (95% CI; -0.34, 2.45) (Z = 1.48)(P = 0.14). Conclusion: Participants in this systematic review range from medical students to fellows; outcomes measure knowledge, skills and competencies and the control groups varied. Despite this heterogenicity CBS is favoured consistently, and the heterogenicity of these results means this evidence is generalisable to a wide educational context within orthopaedic fracture surgery.