Setting and Participants
THA
The study protocol was registered (ISRCTN32225943) and ethical approval was granted prospectively by the Health Research Authority (REC reference: 18/HRA/2085, IRAS ID: 237607). This research was conducted in a specially designed iVR training facility, in the simulation laboratory at Imperial College, London. Between April and October 2021, participants were recruited for one of 2 roles: surgeon or scrub technician. Junior orthopedic surgical residents in their second to fifth year post qualification (foundation year 2 to specialist trainee year 3 in the UK terminology) were eligible to be recruited for the surgeon role. They were excluded if they had previously performed any supervised AA-THA operations, >10 THA operations by any approach, had previous participation in orthopedic surgery iVR simulation, or if they could not commit the required time to the study. Undergraduate nursing students, medical students, and qualified scrub technicians or anesthetic assistants, within their first year of training, were eligible to be recruited for the scrub technician role. Participants were excluded if they had previous experience scrubbing for AA-THA procedures, >1-year experience in an orthopedic scrub role of any kind, prior training in THA instrumentation, previous orthopedic iVR simulation experience, or if they were unable to commit the required time to the study. All participants provided written informed consent to participate.