The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Orthopedic Residency Training Reform in Iran: A Competency-Based Approach

Document Type : RESEARCH PAPER

Authors
Omid salkhori
Nima Bagheri
Seyed Hadi Kalantar
Mohammad Ayati Firoozabadi
Hesan Rezaee
Aidin Arabzadeh
Pouya Tababaei Irani
Mohammadreza Razzaghof
Hamed Naghizadeh
SM Javad Mortazavi
Seyyed Saeed Khabiri
Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran -Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2025.88798.4030
Abstract
Objectives: This study aims to critically evaluate the time-based apprenticeship model currently dominating orthopedic residency training in Iran and to design a competency-based curriculum for the first two years that aligns with modern subspecialized practice while addressing trainee burnout and dissatisfaction.
Methods: We conducted a narrative appraisal of existing Iranian training standards, synthesized resident-reported challenges from regional surveys, and reviewed competency-based frameworks implemented in North America, Europe, and Australasia. Based on these findings, we developed explicit milestones encompassing medical knowledge, technical skills, communication, professionalism, and wellness. An expert panel then iteratively refined the curriculum and aligned appropriate assessment tools with each milestone.
Results: The proposed curriculum delineates 42 measurable competencies across five domains, replacing seniority-based rotation blocks with milestone-triggered progression. It incorporates weekly simulation laboratories, structured feedback, and mentor-led wellness sessions. Comparative analysis demonstrates superior alignment with international standards and suggests enhanced preparedness for fellowship-level practice. A pilot implementation at one academic center revealed increased resident satisfaction and a 30% reduction in reported burnout symptoms after six months.
Conclusion: Transitioning to a competency-based, well-supported curriculum can better prepare Iranian orthopedic residents for contemporary clinical practice while enhancing their overall well-being. Nationwide implementation of this model is recommended.
        Level of evidence: V
Keywords
Competency-based education
Curriculum reform
Iran
Orthopedic residency
Resident wellness
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 1
January 2026
Pages 72-80

  • Receive Date 18 June 2025
  • Revise Date 29 December 2025
  • Accept Date 20 October 2025