Arthroscopic knee simulation in Singapore: Will virtual reality simulation-based training become a mainstay of surgical education?

Traditional orthopedic surgical training follows the Halstedian "see one, do one, teach one" model, which is increasingly challenged by concerns over patient safety, limited operative opportunities, and restricted working hours. Virtual reality (VR)-based arthroscopic knee simulation has emerged as a promising adjunct to conventional training, allowing trainees to practice skills in a risk-free environment. This study evaluates the effectiveness of VR-based arthroscopy training in Singapore and explores its potential integration into surgical education programs. A prospective study was conducted at Singapore General Hospital, involving 30 participants, including Junior Residents, Senior Residents, and Consultants. The Virtamed ArthroS™ virtual arthroscopy simulator was used for training and assessment. Performance metrics such as overall scores, procedural time, safety measures, and camera path length were analyzed before and after training. Statistical analyses, including Wilcoxon Signed-Rank Test, Kruskal-Wallis Test, and correlation analyses, were performed to evaluate skill improvements and the impact of repeated simulation exposure. Significant improvements were observed in overall scores (p < 0.001), overview scores (p < 0.001), and procedural time (p < 0.001), demonstrating enhanced arthroscopic proficiency across all participant groups. However, no significant differences were found between groups in terms of safety scores and camera path length. Consultants initially outperformed Junior and Senior Residents, but post-training assessments showed no significant intergroup differences, suggesting that VR simulation enables skill leveling across experience levels. Correlation analysis indicated weak, non-significant relationships between the number of completed simulations and performance improvements. VR-based arthroscopic knee simulation is an effective training modality that enhances technical proficiency and reduces procedural errors. While the study highlights its potential role in orthopedic education, further research is needed to optimize integration into residency curricula, address technological limitations, and assess long-term skill retention. Widespread adoption in Singapore's orthopedic training programs may help bridge the gap in hands-on surgical exposure, ultimately improving patient outcomes. IV, Cohort studies.