ACKNOWLEDGMENTS
The authors thank Prof Fernando Bello and colleagues for kindly lending us the Distributed Simulation operating room.This study was partially funded by a research support grant from Johnson and Johnson and the Medical Education Research Unit (MERU) at Imperial College London. Infra structure support was provided by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).Ethical approval was granted prospectively by the Health Research Authority (REC reference: 13/HRA/2085, IRAS ID: 237607).Protocol registration: ISRCTN32225943.T.C.E.: conceived initial idea, designed study, data collection/analysis, and drafted manuscript. D.S., S.G., S.K., A.P., and A.P.: collected and analyzed data and edited manuscript. A.D.L.: data interpretation and wrote and edited manuscript. J.P.C.: conceived initial idea, wrote and edited manuscript, and supervision. K.L.: conceived initial idea, designed study, data analysis, and wrote and edited manuscript.T.C.E. declares research funding from Johnson and Johnson, A.D.L. declares research funding from the Royal College of Surgeons of England, J.P.C. declares research funding and paid consultancy from Johnson and Johnson, Zimmer Biomet and JRI, he declares shares/stock in Embody Orthopedic. K.L. declares research funding from Johnson and Johnson, and the Royal College of Surgeons Royal College of Surgeons of England. The remaining authors report no conflicts of interest.Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal’s website, 