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



Salkhori O ; Bagheri N ; Kalantar SH ; Firoozabadi MA ; Rezaee H ; Arabzadeh A ; Irani PT ; Razzaghof M ; Naghizadeh H ; Mortazavi SMJ ; Saberi S ; Khabiri SS
Source: Archives of Bone and Joint Surgery Published:2026

Abstract

Objectives: This study aims to critically evaluate the time-based apprenticeship model currently dominating orthopedic residency trai ning 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. © 2026 Mashhad University of Medical Sciences.