Project Summary/Abstract The long-term goal of this research is to improve patient safety by establishing simulator training and evaluation of surgical skills as essential components of orthopedic residency programs. Many orthopaedic surgeries involve the challenging integration of fluoroscopic image and video interpretation with skillful tool manipulation to achieve well-defined objectives. Simulation has proved beneficial in this context for surgical trainees, but programs have been slow to embrace this advance, and methods for evaluating operating room (OR) performance of these skills to document improvement have been lacking. Objectively measuring skill in the OR is a critical step toward this goal because it allows skills training to be linked to performance in surgery. This is an important missed opportunity. The proposed research will advance objective measurement techniques that are critically needed to speed improvement in resident performance on technical skills, ultimately reducing costs while enhancing patient safety. The long-term goal will be achieved by partnering with the American Board of Orthopaedic Surgery (ABOS) to more tightly integrate surgical skills training and simulation into pre-certification policies. For this reason, researchers at the University of Iowa are leveraging the skills and experience of existing ABOS grant-funded research groups at the University of Rochester and the University of Texas Health in Houston to pursue this goal. The proposed research approach is based on our multi-institution simulation studies with novel surgical simulators and on our previous, AHRQ-funded, ground-breaking analysis techniques for assessing task- specific, detailed, OR performance. Our central hypothesis is that orthopedic surgical skill competence can be objectively, quantitatively, and reliably measured from behaviors observable in fluoroscopy and video routinely collected in the OR. Our research team is well poised for this work; our core multi-disciplinary team of engineers, surgeons, psychometricians have collaborated for nearly a decade to improve orthopedic residency training. Our team is now partnered with the ABOS to advance simulation as a tool for training orthopaedic residents and assessing performance prior to qualifying for certification. Aim 1 of the proposed research is to measure differences in resident OR performance from objective analysis of surgical imagery, and speed up these measurements. Aim 2 is to determine how differences in simulator training correlate with skills demonstrated in the OR, and use this information to improve training programs. Aim 3 is to identify individual differences in skills among residents, both in the skills lab and in the OR, and use this knowledge to improve individual training. This research is innovative because it demonstrates and disseminates new skill assessment techniques critically needed to hasten improvement in orthopedic resident performance, ultimately reducing co...