How Does Cadaveric Simulation Influence Learning in Orthopedic Residents?

•Cadaveric simulation might address the current problem of reduced training time.•It enhances learning in both technical and nontechnical skills in a single training package.•Transfer of skills into the operating theater with resultant patient benefit is reported.•Cadaveric simulation may be of greatest utility around the PGY 4 stage in the UK training system. The objectives of this study were to understand how cadaveric simulation impacts learning in orthopedic residents, why it is a useful training tool, and how skills learnt in the simulated environment translate into the workplace. This is a qualitative research study using in-depth, semistructured interviews with orthopedic residents who underwent an intensive cadaveric simulation training course. The study was conducted at the University Hospital Coventry & Warwickshire, a tertiary care center with integrated cadaveric training laboratory in England, United Kingdom. Orthopedic surgery residents in the intervention group of a randomized controlled trial comparing intensive cadaveric simulation training with standard “on the job” training were invited to participate. Eleven of 14 eligible residents were interviewed (PGY 3-6, 8 male and 3 female). Learning from cadaveric simulation can be broadly categorized into intrinsic, surgeon-driven factors, and extrinsic environmental factors. Intrinsic factors include participant ability to “buy-in” to the simulation exercise, willingness to push one's own learning boundaries in a “safe space” and take out on resident experience and self-reported confidence, with the greatest learning gains seen at around the PGY4 stage in individuals who reported low preintervention operative confidence. Extrinsic factors included; the opportunity to perform operations in their entirety without external pressures or attending “take-over,” leading to subjective improvement in participant operative fluency and confidence. The intensive supervision of subspecialist attending surgeons giving real-time performance feedback, tips and tricks, and the opportunity to practice unusual approaches was highly valued by participants, as was paired learning with alternating roles as primary surgeon/assistant and multidisciplinary involvement of scrub-staff and radiographers. Cadaveric simulation added educational value beyond that obtained in low-fidelity simulation training by “stirring into practice” and “becoming through doing.” In providing ultrarealistic representation of the space, ritu