Bridging the gap: A scoping review of wet and dry lab simulation training in orthopaedic surgical education

BACKGROUND: Orthopaedic surgical education has traditionally depended on the apprenticeship model of "see one, do one, teach one". However, reduced operative exposure, stricter work-hour regulations, medicolegal constraints, and patient safety concerns have constrained its practicality. Simulation-based training has become a reliable, safe, and cost-efficient alternative. Dry lab techniques, especially virtual and augmented reality, make up 78% of current dry lab research, whereas wet labs still set the standard for anatomical realism. AIM: To evaluate the effectiveness, limitations, and future directions of wet and dry lab simulation in orthopaedic training. METHODS: A scoping review was carried out across four databases-PubMed, Cochrane Library, Web of Science, and EBSCOhost-up to 2025. Medical Subject Headings included: "Orthopaedic Education", "Wet Lab", "Dry Lab", "Simulation Training", "Virtual Reality", and "Surgical Procedure". Eligible studies focused on orthopaedic or spinal surgical education, employed wet or dry lab techniques, and assessed training effectiveness. Exclusion criteria consisted of non-English publications, abstracts only, non-orthopaedic research, and studies unrelated to simulation. Two reviewers independently screened titles, abstracts, and full texts, resolving discrepancies with a third reviewer. RESULTS: From 1851 records, 101 studies met inclusion: 78 on dry labs, 7 on wet labs, 4 on both. Virtual reality (VR) simulations were most common, with AI increasingly used for feedback and assessment. Cadaveric training remains the gold standard for accuracy and tactile feedback, while dry labs-especially VR-offer scalability, lower cost (40%-60% savings in five studies), and accessibility for novices. Senior residents prefer wet labs for complex tasks; juniors favour dry labs for basics. Challenges include limited transferability data, lack of standard outcome metrics, and ethical concerns about cadaver use and AI assessment. CONCLUSION: Wet and dry labs each have unique strengths in orthopaedic training. A hybrid approach combining both, supported by standardised assessments and outcome studies, is most effective. Future efforts should aim for uniform reporting, integrating new technologies, and policy support for hybrid curricula to enhance skills and patient care.