The AOA 21 journey of development and improvement

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AOA is committed to delivering globally recognised training that prepares orthopaedic surgeons for the highest standards of professional practice and patient care. We continually review, reflect, refine; and redevelop, when needed.

The AOA 21 Training Program for orthopaedic surgery was launched in 2018, after an international review recommended a shift from time-based to competency-based training. This transformation aligned Australian orthopaedic training with global best practice and set a new standard for surgical education in Australia.  

In 2022–23, AOA conducted a detailed review of the AOA 21 training program, confirming that most of the original aims had been achieved and highlighting opportunities for ongoing improvement.

Looking ahead, AOA is implementing refinements through to 2028: sharpening, streamlining and enhancing the training program. 

AOA 21 - our journey of development and improvement pic (for main page)

AOA acknowledges the many individuals who have shaped, delivered, and evolved this program.

In 2012, an independent international review of AOA’s Surgical Education and Training (SET) program recommended a shift from a time-based to a competency-based model. The outcome was AOA 21, launched in 2018. This transformation marked a milestone in advancing surgical education and training in Australia.

Read more on the 2012 review:  Incoll, I.W., et al. (2020). Australian orthopaedic surgery training: AOA’s strategic education review. ANZ Journal of Surgery, 90(6), 997–1003.

(Access via publisher website; subscription may be required)

In response, AOA 21 was established as a modernised, competency-based training program designed to support high-quality orthopaedic surgical education through a clear and structured curriculum. Progression is based on demonstrated capability, rather than simply time spent in training. This marked an important step forward in how orthopaedic surgeons are trained in Australia.

Development took place in two phases:
  • Phase 1 focused on building the foundations of the program, including curriculum design, contemporary assessment, learning and feedback approaches, and supervisor development to support implementation.
  • Phase 2 broadened the focus to include selection, accreditation, research, and continuing professional development, helping to ensure a coherent and sustainable training journey.

Following five years of delivery of the competency-based program, AOA undertook an extensive program review in 2022-23, informed by a comprehensive evaluation of the AOA 21 Training Program by an international team.  This review found that most of AOA 21’s original aims had been achieved, while also identifying opportunities for improvement.

  • Access the AOA 21 Review Report, September 2023. 
    (Access is restricted to AOA members. Log in is required)

Building on these findings, AOA is advancing the next phase of refinement, with progressive rollout planned through to 2028. Current development efforts are focused on strengthening communication and engagement, curriculum, supervisor support, training setting accreditation, and the operational systems that underpin the program.

AOA 21’s journey has unfolded step by step, from the 2012 external review, to the launch of the program in 2018 and through its first comprehensive international evaluation in 2022-23. It is now well into the next phase of refinement, which will continue through to 2028.

The success of AOA 21 depends on the dedication of orthopaedic consultants across Australia – those who teach, supervise, assess, coach, and serve on committees to support delivery.

AOA acknowledges the many individuals who have shaped, delivered, and evolved this program – from those who developed its original vision, to those who brought it to life, and to those refining it for the future.  The AOA 21 Training Program reflects their collective effort.

This work is in service of the Australian community and the patients who place their trust in orthopaedic surgeons. We look forward to continuing this journey together.

“The road to change is never without challenges, but you’ve embraced them to create a world-class surgical program. Remember that you’re now forging ahead with refinement rather than revolution.”
– Professor Jason Frank.

Architect of CanMEDS, Director at Canada’s Royal College, chair of AOA’s 2012–13 and 2022–23 training program reviews.