From the Guidelines
Surgical training today faces numerous significant challenges that impact the development of competent surgeons, and addressing these challenges requires innovative educational approaches to ensure surgeons are adequately prepared for independent practice despite these constraints. The primary challenges include reduced operative time due to work hour restrictions, which limit residents' exposure to complex cases and decrease opportunities for hands-on experience, as noted in various studies 1. Additionally, the increasing complexity of surgical procedures, particularly with the adoption of minimally invasive techniques and robotic surgery, requires trainees to master multiple approaches and technologies simultaneously. Patient safety concerns have also shifted the traditional "see one, do one, teach one" model toward simulation-based training, which, while beneficial, cannot fully replicate real surgical experiences.
Some key challenges in surgical training include:
- Reduced operative time due to work hour restrictions
- Increasing complexity of surgical procedures
- Need for innovative educational approaches to address these challenges
- Importance of simulation-based training and other educational methods to prepare surgeons for independent practice
The growing administrative burden on surgical programs diverts time from clinical teaching, while the pressure to maintain hospital efficiency often prioritizes throughput over educational opportunities. Furthermore, the COVID-19 pandemic disrupted surgical training by reducing elective procedures and clinical rotations. These challenges are compounded by the need to balance technical skill development with other essential competencies like communication, leadership, and systems-based practice, all while addressing trainee wellness and burnout in a high-stress specialty.
To address these challenges, innovative educational approaches, including simulation, virtual reality, structured assessment methods, and curriculum redesign, are necessary to ensure surgeons are adequately prepared for independent practice. The Association of Surgeons in Training has made recommendations for improving surgical training, including the use of mentoring programs and the development of a more robust system to support trainees 1. The future of surgical training will require a shift towards more flexible and personalized training pathways, as well as a greater emphasis on lifelong learning and professional development, as noted in the Shape of Training Review 1.
From the Research
Challenges in Surgical Training
- Shortened working hours and less training times are significant challenges in surgical training today, necessitating the acquisition of skills outside the operating room 2
- Patient safety issues also pose a challenge, highlighting the need for effective training methods that minimize risks to patients 2, 3
- The traditional apprenticeship model of surgical training has limitations, including variable effectiveness and high costs, prompting the need for alternative training methods such as simulation-based training 3, 4
Effective Training Methods
- Virtual reality (VR) simulation training has been shown to be effective in improving technical skills and reducing operating time for surgical trainees 2, 3, 5
- Procedural VR simulation training has been found to be more effective than basic VR training and no training in improving technical skills for robotic surgery 5
- The use of artificial intelligence (AI) and large language models (LLMs) in surgical training is a promising area of innovation, with potential applications in enhancing communication, personalizing feedback, and promoting skill development 6
Future Directions
- Further research is needed to assess the impact of VR simulation training on patient outcomes and hospital costs 2, 3
- The development of standardized, objective, and validated assessment tools is necessary to measure surgical skills in simulation-based training 4
- The integration of AI and LLMs into surgical training requires careful consideration of challenges such as accuracy, reliability, and ethical concerns 6