The Application of Three-Dimensional Technologies in the Improvement of Orthopedic Surgery Training and Medical Education Quality: A Comparative Bibliometrics Analysis

Abstract

Orthopedics is a medical specialty that focuses on the clinical treatment and care of the musculoskeletal system. Orthopedics is a medical specialty which specializing in the clinical treatment and nursing of musculoskeletal system. The education of orthopedics is often serious and difficult because of the high technical requirements, complicated anatomical knowledge and long study process. However, medical students or junior residents rarely have the opportunity to see such orthopedic surgery or attend preclinical practice, which limits the opportunities for training clinicians. Hopefully, with the increasing use of three-dimensional (3D) technologies in medical teaching, this situation can be alleviated. In this study, we demonstrate that different 3D technologies can effectively simulate orthopedic surgery with very high accuracy. We carefully evaluated the use of 3D technologies in primary medical teaching and proposed a vision for the future. We searched and screened 3,997 publications from the Web of Science Core Collection (WoSCC) on 22 Oct 2021 with (trauma) AND ((education) OR (training) OR (teaching) OR (learning)) AND ((3D) OR (Three Dimensional)), (Joint) AND ((education) OR (training) OR (teaching) OR (learning)) AND ((3D) OR (Three Dimensional)), (spine) AND ((education) OR (training) OR (teaching) OR (learning)) AND ((3D) OR (Three Dimensional)) as the search strategy. Then, we eliminated the publications irrelevant to "orthopedics" AND/OR "orthopaedic" (in United Kingdom English), the final number of publications are 440 for trauma surgery, 716 for joint surgery and 363 for spine surgery, a visual display of comprehensive information analysis was made by VOSviewer. Next, we read and analyzed retrieved articles extensively according to the selection criteria, 11 highly cited publications on three major branches of orthopedics were chosen. The extracted data included the authors, purpose, methods, results and benefits/limitations. The evaluation of these studies directly and objectively proved the superiority of 3D technologies in orthopedics. Furthermore, the material usage and strength of 3D technologies can be closer to the real situation, which will help improve their effectiveness in teaching. We hope that more relevant studies will be conducted to continue examining the effects of 3D technologies on orthopedic medical education as well as orthopedic surgery training, and we hope that this technique can be more widely used in the clinical teaching of orthopedics to train clinicians on learning medical theory and surgical technology quickly and efficiently.

Keywords: 3D printing; bibliometrics analysis; education and patients counseling; methodology; orthopedics; surgical simulation and training; three-dimensional technologies.

FIGURE 1

Visualized images of keywords clustering from different sections. (A) The all keywords of trauma surgery related publications. (B) The all keywords of joint surgery related publications. (C) The all keywords of spine surgery related publications. (The correlation between the two keywords refers to how many publications the two keywords have appeared together. Here, the more links between the two bubbles, the more publications they appear together, and the stronger the correlation. In addition, we conduct cluster analysis according to the correlation of keywords, and divide all keywords into multiple clusters. Bubbles in the same cluster have the same color, that is, they have stronger correlation.)

FIGURE 2

Visualized images of all keywords clustering. (Larger bubbles represent a higher number of occurrences of the keyword in these publications. There are more connections between bubbles closer in space, which means they have a higher chance of appearing together in a publication. In addition, bubbles with brighter colors represent a higher occurrence rate in recent publications, while dark bubbles tend to appear in past publications).

FIGURE 3

Density visualization of the countries’ distribution of all the publications. (Analyzing is based on the co-authorship of the countries, spatially closer bubbles show that they are close to the same cluster during clustering, which proves that their cooperation relationship is closer. In addition, the brighter the bubbles represent a higher number of publications of the country in the field of 3D technology in orthopedics education).

FIGURE 4

Visualization of number of publications for the top ranked countries. (A) The annual publication data of the top countries in terms of application of 3D technology in trauma surgery education and training. (B) The annual publication data of the top countries in terms of application of 3D technology in joint surgery education and training. (C) The annual publication data of the top countries in terms of application of 3D technology in spine surgery education and training. (Cumulative figure of the number of published articles in the top countries in the three fields of trauma, joint and spine from 2000 to 2021, which reflects the in-depth research of each country in the three fields).

FIGURE 5

Visualization of institutional cooperation and publication period. (The links between the boxes reflects the number of cooperation, and the closer it is arranged in space, the deeper its cooperation relationship is. In addition, in terms of time, the brighter the color, the more research results the institution has made in recent years, and the darker the color, the more contribution it may have made in the past).

FIGURE 6

Combinated visualization of number of publications and impact factor for the top-cited journals. (The bar chart reflects the number of publications, and the line chart reflects the impact factors. According to statistics, among all publications sources, these journals have a number of publications published which is no less than 11).