Extended reality and emerging artificial intelligence in orthopedic surgical training: a scoping review of educational outcomes
Clinical Snapshot
PICO Framework
| P — Population | Medical students, residents, and orthopedic trainees |
| I — Intervention | Extended reality (XR) including virtual reality, augmented reality, and artificial intelligence applications in surgical training |
| C — Comparator | Traditional surgical training methods or control groups |
| O — Outcomes | Educational outcomes including technical performance metrics, skill acquisition, knowledge retention, and clinical competence |
Bottom Line
This scoping review of 54 studies demonstrates that extended reality, particularly virtual reality, shows promise for enhancing orthopedic surgical training, with most applications focused on trauma surgery, arthroscopy, and arthroplasty. While simulation-based performance metrics consistently improve, the evidence base remains limited regarding clinical outcomes, long-term skill retention, and cost-effectiveness. Artificial intelligence applications are still emerging and primarily supportive rather than standalone training tools. The heterogeneous nature of outcome measures and study designs limits the ability to draw definitive conclusions about optimal implementation strategies. For Australian orthopedic training programs, XR technology represents an evolving educational tool that may complement traditional training methods, but requires careful evaluation of infrastructure costs, curriculum integration, and long-term educational impact before widespread adoption. Future research should prioritize standardized outcome measures and multicenter studies to establish evidence-based implementation guidelines.
Key Findings
P Value: Not applicable for scoping review
Effect Size: Not quantified in abstract - scoping review format
Primary Outcome: Educational effectiveness of XR and AI in orthopedic surgical training
Nnt Or Sensitivity: 83.3% of studies used VR, 31.4% used AR, with improvements in simulation-based technical performance metrics
Confidence Interval: Not applicable for scoping review
Clinical Application
Moderate - requires significant technological infrastructure and investment in XR equipment and software Relevant to Australian orthopedic training programs through RACS and medical schools; may require consideration of TGA approval for medical device applications and integration with existing curriculum standards Medical students, orthopedic residents, and practicing orthopedic surgeons in training programs
Abstract
Immersive technologies have gained increasing relevance in orthopedic surgical education; however, the scope, outcomes, and maturity of extended reality (XR) and artificial intelligence (AI) applications remain heterogeneous. To map the educational applications, learner populations, outcome measures, and research gaps related to the use of XR and emerging AI tools in orthopedic surgical training. A scoping review was conducted following Joanna Briggs Institute methodology and reported according to PRISMA-ScR guidelines. PubMed, Scopus, and ScienceDirect were searched for English and Spanish studies published between 2015 and 2025. Fifty-four studies involving 3,066 participants were included. Virtual reality (VR) was the predominant modality (83.3%), followed by augmented reality (31.4%), while AI-based applications were infrequently reported. XR-based training was most commonly evaluated in trauma surgery, arthroscopy, and arthroplasty, primarily among medical students and residents. Most studies reported improvements in simulation-based technical performance metrics, whereas evidence on clinical outcomes, long-term skill retention, and cost-effectiveness was limited. XR-particularly VR-represents the most mature immersive technology in orthopedic surgical education. AI applications remain emergent and primarily supportive. Future research should prioritize standardized outcome measures, multicenter designs, and evaluation of long-term educational and clinical impact.
References
- 1.Molina, V. M., Medina, R. A. B., Mora, J. S. M., & Rincón, E. H. H. (2026). Extended reality and emerging artificial intelligence in orthopedic surgical training: a scoping review of educational outcomes. Journal of Robotic Surgery. https://doi.org/10.2147/AMEP.S395087
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