Constructing surgical confidence through simulation: A qualitative exploration in orthopaedic training

Simulation-based training is widely used within surgical education. Although confidence is frequently evaluated as a post-training outcome, less attention has been given to how trainees experience confidence development in relation to preparedness for operative participation. This study explored how orthopaedic trainees develop confidence and perceived preparedness during simulation-based Dynamic Hip Screw (DHS) fixation training.

A qualitative study was undertaken with ten Core Surgical Trainees (CT1-CT2) at a UK teaching hospital. Participants completed DHS fixation simulation using sawbone models and procedure-specific orthopaedic instrumentation, followed by a semi-structured focus group. Data were analysed using reflexive thematic analysis, with interpretation informed by Kolb's Experiential Learning Theory.

Four interconnected processes characterised confidence development: experiential learning through practice and decision-making, technical familiarity, collaborative learning, and authentic engagement. Participants described progressing from uncertainty towards greater procedural familiarity and perceived preparedness through repeated practice, feedback, reflection and social interaction. Confidence extended beyond technical performance to include procedural sequencing, decision-making, communication and anticipation of future operative participation. Simulation was regarded as preparation for, rather than a substitute for, supervised clinical experience.

Procedure-specific simulation supported perceived preparedness for supervised operative participation through interacting technical, cognitive and collaborative learning processes. Its educational value may lie not simply in increasing confidence, but in supporting confidence grounded in procedural familiarity, feedback and authentic engagement.