High-Fidelity Orthopaedic Surgical Skills Models and Resident Performance in the Surgical Treatment of Tibial Plateau Fractures


The purpose of this study was to quantify the impact of low-fidelity simulation on resident surgical skills education. Fourteen orthopaedic surgery residents (PGY-1 through PGY-5) were separated into two, training-level-matched cohorts – an untrained control cohort (UCC) and a low-fidelity Sawbones training cohort (SAW). Together, both cohorts received didactic instruction on the soft-tissue approach, intra-operative reduction, internal-fixation, and surgical wound closure of Schatzker II tibial plateau fractures. The SAW cohort first rehearsed open-reduction, internal-fixation on radiopaque Sawbones models (Pacific Research Laboratories Inc. Vashon, WA). Both cohorts were then evaluated while performing the same procedure on high- fidelity cadaveric models (Rimasys GmbH Cologne, Germany). Surgical skill and knowledge were assessed using the objective structured assessment of technical skills (OSATS) tool, a written exam, and an after-action survey. There were no significant differences in OSATS scores or written exam scores between the two cohorts. A near-linear positive relationship (R2 = 0.9737) existed between training year and average overall OSATS score. All residents expressed a preference for surgical skills training with high-fidelity cadaveric models. The results of this study fail to demonstrate a training advantage of low-fidelity Sawbones models when surgical skill is measured on high-fidelity cadaveric models. Despite this, residents across both cohorts qualitatively felt the high-fidelity models offered a better educational opportunity for surgical practice than did the low-fidelity Sawbones models. (Journal of Surgical Orthopaedic Advances 31(2):109–112, 2022)

Key words: resident education, graduate medical education, healthcare simulation, surgical simulation, surgical skills, sawbones, tibial plateau

Joshua Kotler, MD, MC, USN; Jennifer Sanville, MS; Joy Greer, MD, MC, USN; and Christopher Smith, MD, MC, USN