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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
Summary
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
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.
