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  1. Home
  3. Immersive Virtual Reality Simulation-based Assessments In Orthopedic Surgery: A Systematic Scoping Review.
  1. Home
  3. Immersive Virtual Reality Simulation-based Assessments In Orthopedic Surgery: A Systematic Scoping Review.

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Immersive Virtual Reality Simulation-Based Assessments in Orthopedic Surgery: A Systematic Scoping Review.

Mads Emil Jacobsen1,2,3, Rasmus Drews Wenda1, Mikkel Engell Sandager Nielsen2,3

  • 1Center for Orthopaedic Research and Innovation (CORI), Department of Orthopaedic Surgery, Central and West Zealand Hospital, Slagelse, Denmark.

JBJS Reviews
|June 24, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Immersive virtual reality (iVR) assessments in orthopedic surgery lack sufficient validity evidence for interpreting performance scores. This scoping review highlights the need for stronger evidence across all Messick

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Area of Science:

  • Medical Education
  • Surgical Training
  • Virtual Reality Technology

Background:

  • Immersive virtual reality (iVR) is increasingly adopted for orthopedic surgical training, offering automated metrics for competency-based programs.
  • A critical gap exists in understanding the validity evidence supporting iVR-based assessments in this field.
  • This study addresses the need to evaluate the robustness of iVR assessment tools in orthopedic surgery.

Purpose of the Study:

  • To conduct a scoping review of iVR-based assessments in orthopedic surgery.
  • To map the existing validity evidence using Messick's framework.
  • To identify limitations in current iVR assessment validity.

Main Methods:

  • Searched PubMed and Embase for studies on technical performance in orthopedic iVR simulations, adhering to PRISMA-ScR guidelines.
  • Two reviewers screened studies, extracted data, and appraised validity evidence using Messick's framework and the Ghaderi scoring instrument.
  • Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI); data were synthesized descriptively.

Main Results:

  • Eighteen studies involving 11 orthopedic procedures met inclusion criteria.
  • Validity evidence supporting score interpretation was limited across Messick's five domains (median Ghaderi score: 2.5/15), with 'relations to other variables' being most addressed.
  • Internal structure and consequences evidence were notably absent; methodological quality was generally high (median MERSQI: 13.5/18), but reporting quality was inconsistent.

Conclusions:

  • Current iVR-based assessments in orthopedic surgery lack sufficient validity evidence for meaningful performance score interpretation.
  • The field risks prioritizing technological advancement over genuine assessment quality.
  • Enhancing iVR assessment requires defined constructs, systematic validity evidence across Messick's domains, and improved reporting standards.