Surgeons as co-creators: the SuFI model for embedding innovation in surgical education

Background: Artificial intelligence (AI)-based simulation is an emerging innovation in surgical education, offering a safe, interactive, and data-driven environment for skill development. Traditional apprenticeship models are increasingly limited by reduced operative exposure, patient safety concerns, and variability in clinical training. Understanding residents’ acceptance of AI technologies is essential for effective integration into surgical education. Aim: This study aimed to assess surgical residents’ acceptance and perceived usefulness of AI-based simulation in surgical training at Saidu Teaching Hospital, Swat. Methodology: An analytical cross-sectional study was conducted among 80 surgical residents from various specialties using non-probability convenience sampling. Data were collected through a structured, self-administered questionnaire based on the Technology Acceptance Model, including demographic variables and Likert-scale items assessing perceived usefulness and acceptance. Data were analyzed using statistical package for the social sciences (SPSS) version 27. Descriptive statistics, Pearson correlation, independent t-tests, and one-way ANOVA were applied, with p ≤ 0.05 considered statistically significant. Results: Residents reported high perceived usefulness (mean 3.87 ± 0.58) and acceptance (mean 3.74 ± 0.62) of AI-based simulation. A strong positive correlation was found between perceived usefulness and acceptance (r = 0.68, p < 0.001). No significant gender differences were observed, while acceptance varied significantly across training years (p = 0.041). Conclusion: AI-based simulation is well accepted among surgical residents. Early integration, faculty training, and blended learning approaches are recommended to enhance surgical skill acquisition.

Background: Artificial intelligence (AI)-based simulation is an emerging innovation in surgical education, offering a safe, interactive, and data-driven environment for skill development. Traditional apprenticeship models are increasingly limited by reduced operative exposure, patient safety concerns, and variability in clinical training. Understanding residents’ acceptance of AI technologies is essential for effective integration into surgical education. Aim: This study aimed to assess surgical residents’ acceptance and perceived usefulness of AI-based simulation in surgical training at Saidu Teaching Hospital, Swat. Methodology: An analytical cross-sectional study was conducted among 80 surgical residents from various specialties using non-probability convenience sampling. Data were collected through a structured, self-administered questionnaire based on the Technology Acceptance Model, including demographic variables and Likert-scale items assessing perceived usefulness and acceptance. Data were analyzed using statistical package for the social sciences (SPSS) version 27. Descriptive statistics, Pearson correlation, independent t-tests, and one-way ANOVA were applied, with p ≤ 0.05 considered statistically significant. Results: Residents reported high perceived usefulness (mean 3.87 ± 0.58) and acceptance (mean 3.74 ± 0.62) of AI-based simulation. A strong positive correlation was found between perceived usefulness and acceptance (r = 0.68, p < 0.001). No significant gender differences were observed, while acceptance varied significantly across training years (p = 0.041). Conclusion: AI-based simulation is well accepted among surgical residents. Early integration, faculty training, and blended learning approaches are recommended to enhance surgical skill acquisition.

These are challenging times for Surgical Educators. Limitations on working hours, resource constraints, rapidly evolving technological advances in the way, we communicate and interact, and increasing patient expectations are threatening the traditional and time-tested apprenticeship model of surgical training. It is imperative on the part of today's Surgical Educators to respond to these challenges in ways that enhance and promote the training of future surgeons. This has led to the birth of a new specialty of Surgical Education. Although generic Health Sciences/Medical Education programs are widely available and do serve a useful purpose, it may be argued that surgical trainees have unique needs that may not be adequately addressed by the generic programs. Thus, there is a need for focused Surgical Education programs. This review aims to identify these needs and to discuss the current Surgical Education programs available. It also aims to suggest additional issues that may need to be addressed to make these programs even more useful.

Surgical Education Research 1

Incorporating surgical skills education in trauma care is essential for young surgeons and surgical trainees. This study describes an innovative e-learning course for teaching trauma care surgical skills in an international cooperative setting. Furthermore, it aims to offer valuable insights on enhancing e-learning practices. The Panamerican Trauma Society and the Spanish Surgical Association have joined forces to launch an online course focusing on advanced trauma care surgical skills. This report provides an in-depth examination of the project and scrutinizes participant feedback through a post-course survey. The survey thoroughly evaluates their satisfaction level, the usefulness of the course content, and their view on its clinical relevance. Three hundred eighty-two surgeons from 16 countries completed an online course. Three hundred seventy-nine of them responded to the post-course survey. The mean age was 36, with 64% females and 36% males. The course consisted of 9.9h of academic content, including 5h of video lectures and 4.9h of live discussions. Ninety-seven percent of the participants were practicing general and acute care surgeons, and only 2% were exclusively dedicated to trauma surgery. Sixty-one percent of participants highly valued real-time interaction with faculty, and 95% believed their trauma surgical skills would improve. Additionally, 93% of the participants were satisfied or very satisfied with the e-learning experience. The use of video-based instructional materials has revolutionized surgical education. With online courses in trauma surgery, surgeons can now improve their skills and better prepare themselves to handle severe trauma cases. This innovative approach to surgical education has proven to be very effective and can potentially enhance patients' quality of care.

techniques are fuelling the need for more vascular surgeons. Attracting, recruiting, and retaining the essential workforce have been identified as crucial parts of the strategy to cover this need. The skills required in vascular surgery should ideally be acquired at an early age. Patient safety in surgery not only requires practical skills but also the ability to collaborate with the surgical team. Many situations in cardiovascular surgery require interdisciplinary approaches, including management of lung cancer surgery, complex robotic operations, and postoperative monitoring (2). The integration of interprofessional education in cardiothoracic training programs varies, but simulation-based training has gained increasing recognition as a way of improving team performance, crisis management, and patient safety. The same probably applies to other surgical disciplines.In critical situations and when the healthcare system's infrastructure is strained, traditional teaching methods become difficult. This became a reality to manage during the COVID-19 pandemic (3) (4) (5). Telemedicine, virtual courses, and increased reliance on virtual simulation training are among the strategies employed to address the challenges encountered in surgical education during the epidemic. Although these teaching methods cannot fully replace real-life training and have elicited varying levels of satisfaction among trainees, they have remained part of the teaching agenda even after the epidemic. Future development of teaching should focus on integrating new virtual methods with real-life skills training.Training in simulated environments may be a safe way to improve surgical dexterity, but it requires reliable feedback to be effective. Supervision and feedback from an experienced surgeon may enhance skill acquisition, but are subject to rater bias, inconsistent standards, and inefficiency. Repetitive practice of fundamental skills, such as laparoscopic knot-tying, is crucial for developing dexterity but should ideally be continuously evaluated to be effective.Objective and automated evaluations have been used to quantify hand gestures, eye movements, or instrument handling. Reliability Volume is an approach that involves registering the instrument trajectory to account for spatial accuracy and performance consistency across multiple sessions (6). Reliability is the probability of completing the task in a virtual simulated environment under specified conditions, and Volume denotes the corresponding workspace volume. Reliability Volume provides feedback that is not subject to human-assessor bias and still offers a dynamic, comprehensive, and practice-oriented assessment framework defined by a standard established by an experienced surgeon.Artificial intelligence has also been used to track hand motions and enhance surgical training.Economic and precise hand motions are signs of dexterity that may be assessed using sensors in simulated environments. By integrating artificial intelligence algorithms into hand and instrument tracking, more effective and targeted feedback is provided. Machine learning, including supervised, unsupervised, reinforced, and deep learning, offers distinct training paradigms (7). These are relatively new tools in surgical education, but advances in machinelearning methods are expected.Virtual simulated environments offer many advantages but cannot completely replace physical models. Hernia repair and appendectomy are some of the most common surgical procedures and are among those that surgical trainees are expected to master early in their training. There are, however, no good models for hernia surgery training, and those used for appendectomy have limitations. Single-use synthetic training models for appendectomy training are commercially available, but they are costly and not accessible to all trainees. However, silicon is relatively cheap and suitable for creating appendicitis models. Because silicone can be varied in stiffness and colour, it can simulate different tissues. In a validation study, a silicone model designed for laparoscopic appendectomy simulation effectively enabled residents to perform most critical procedural steps (8).The methods for teaching surgery will likely continue to evolve, incorporating new technologies for effective feedback while also addressing the need to adapt these methods to emerging surgical techniques. Effective teaching that does not compromise patient safety is crucial not only for tertiary centres and centres of excellence, but also for the community at large and for healthcare systems with limited resources.

Over the past few decades, technological advancements have established digital tools as an indispensable pedagogical resource in the realm of modern education. In the field of medical education, there is growing interest inhow these digital tools can be effectively integrated to enhanceundergraduate surgical education. However, despite their well-documented potential benefits, research specifically investigating the current use of digital technology inundergraduate surgical education remains limited,highlighting a critical gap in the existing literature. To address this research gap, this scoping review aims to elucidate the current utilisation of digital technologies in undergraduate surgical education by addressing the research question: 'How are digital technologies currently being utilised in undergraduate surgical education to meet surgical learning outcomes'. A scoping review was performed, adopting the Joanna Briggs Institute (JBI) framework. A comprehensive search strategy was conducted using the search terms 'technology' OR 'simulation' OR 'virtual reality' OR 'augmented reality' OR 'digital' OR 'online' AND 'undergraduate' AND 'surgical' on multiple electronic bibliographic databases including PubMed, Medline, ERIC, Embase, Scopus and Web of Science. These search terms were executed using both free-text and MeSH terms, with search terms combined using Boolean operators to ensure all relevant citations were captured. All search results were screened against the eligibility criteria using Covidence, a web-based software platform, using a two-stage process. Subsequently, all included studies were reviewed, and the extracted data was systematically sorted and organised, with the findings presented graphically accompanied by descriptive narratives. A thematic analysis was also performed to identify themes within the data to synthesise key findings. This scoping review revealed three key findings. First, the use of digital tools in surgical education has been steadily increasing over the past few decades, with the COVID-19 pandemic accelerating the integration of technology into surgical education. Second, this review also highlighted the key role of anatomy within surgical education, with most included studies reporting the use of digital technologies to enhance anatomy teaching. Finally, this review provided an overview of various digital tools used in surgical education and their associated user experiences. Overall, most studies indicated that digital technologies are well-received by students, with many advocating for their continued use insupplementing surgical education even beyond the pandemic. This review provides a crucial foundation for understanding the evolving role of digital innovations in shaping undergraduate surgical education. To enhance undergraduate surgical education, integrating appropriate digital learning tools can provide more learner-centred and personalised learning experiences. Educators must recognise that there is no 'one-size-fits-all' approach, and a flexible multimodal strategy is necessary to meet diverse learning needs. As technology continues to evolve and its role in education grows, this review offers valuable insights into the current use of digital tools in surgical education, highlighting opportunities for improvement and innovation to further enhance undergraduate surgical experience.

Simulation-based surgical skills training addresses several concerns associated with the traditional apprenticeship model, including patient safety, efficient acquisition of complex skills, and cost. The surgical specialties already recognize the advantages of surgical training using simulation, and simulation-based methods are appearing in surgical education and assessment for board certification. The necessity of simulation-based methods in surgical education along with valid, objective, standardized techniques for measuring learned skills using simulators has become apparent. The most commonly used surgical skill measurement techniques in simulation-based training include questionnaires and post-training surveys, objective structured assessment of technical skills and global rating scale of performance scoring systems, structured assessments using video recording, and motion tracking software. The literature shows that the application of many of these techniques varies based on investigator preference and the convenience of the technique. As simulators become more accepted as a teaching tool, techniques to measure skill proficiencies will need to be standardized nationally and internationally.

In the rapidly advancing landscape of surgical education, the traditional apprenticeship model is being increasingly complemented by individualized learning, competency-based assessment, and data-driven feedback. Work-hour restrictions, administrative burdens, and limited operative exposure have intensified the need for innovative solutions to supplement faculty-led training. Artificial intelligence (AI) has emerged as a promising adjunct, offering scalable platforms for technical skill acquisition, personalized feedback, and structured progress tracking. Early applications include AI-guided simulation, feedback, natural language processing for resident evaluation, and advanced applicant-screening systems, which hold the potential to streamline holistic review while reducing faculty workload. Despite these advances, significant challenges remain, including bias mitigation, ethical data governance, and the need for rigorous outcome-based validation. The greatest promise lies in hybrid models, where AI augments rather than replaces mentorship, freeing faculty for complex, context-dependent teaching. With careful implementation, AI is poised to meaningfully transform surgical education worldwide.

Telemedicine has become a vital element of modern surgical practice, facilitating virtual consultations, intraoperative collaboration, and postoperative monitoring. One of its most innovative applications is remote proctoring, or teleproctoring—the real-time supervision and assistance of surgical procedures across distances. The COVID-19 epidemic has accelerated the impact of these technologies on surgical education, credentialing, and global access to specialized expertise. This narrative review synthesizes literature from 2005 to 2025 obtained from PubMed, ResearchGate, Web of Science, and Google Scholar. The emphasis includes telemedicine and remote proctoring in surgical care, education, and quality assurance. Chosen materials comprise original investigations, systematic reviews, and policy documents that pertain to technical platforms, clinical outcomes, educational applications, implementation issues, and regulatory considerations.  Modern teleproctoring technologies include secure, low-latency, high-definition video broadcasts enhanced by augmented reality features and telestration capabilities. The available evidence, primarily from observational studies, confirms the approach's viability, cost-effectiveness, improved training efficiency, and high user acceptance across disciplines such as minimally invasive, robotic, and endoscopic surgery. However, inconsistencies in outcome measurements, a lack of randomized controlled trials, and varying legal frameworks restrict wider applicability. The safety profiles appear promising, yet data deficiencies remain. Telemedicine and remote proctoring are developing into integral components of surgical care. Essential future directions include the implementation of artificial intelligence solutions, the development of standardized outcome metrics, the execution of comparative research, the enhancement of cybersecurity measures, and the promotion of fair access in resource-constrained settings. When integrated within strong regulatory and ethical frameworks, remote proctoring has the potential to function as a fundamental pillar of efficient and interconnected global surgical practice.

To the Editor: We are concerned that the anatomy demonstratorship (a rotation dedicated to anatomy-specific training in surgical education), which in the past has often served a primary role in surgical training and education in the United Kingdom, is now experiencing a decline. This has occurred even though it has been reported that surgical trainees who have chosen to demonstrate anatomy have a greater chance of passing the written examination to obtain an Intercollegiate Membership in the Royal College of Surgeons (MRCS).1 This has occurred largely because of a shift of the MRCS curriculum away from extensive knowledge of gross anatomy. In addition, the arrival of Modernising Medical Careers (MMC)2—the United Kingdom's model for postgraduate medical and surgical training—has also limited the viability of the anatomy demonstratorship, although in other areas it has brought about many improvements. With the introduction of run-through and extended rotations in surgical training that are geared toward acquisition of dedicated clinical and practical competencies, the incorporation of posts (i.e., rotations), including the anatomy demonstratorship, that are classically not recognized for training accreditation has been difficult. We agree with the principles of the MMC. It is paramount that our country produce doctors who are competent and who can establish and determine skills against set standards.3 It is, however, equally important that we do not lose sight of the value of the anatomy demonstratorship in attainment of surgical training and education. We would encourage further discussion between the deaneries and the surgical colleges to facilitate further inclusion of anatomy demonstratorship rotations into modernized surgical training. Ashim Mannan, MBBS Core surgical trainee year 2, Head and Neck Surgery, Leeds General Infirmary, Leeds, Yorkshire, United Kingdom; [email protected]. Simon Carr, MBBS, DOHNS, MRCS Specialist registrar, Head and Neck Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom. Zvoru Makura, MBChB, FRCSEd, FRCS (ORL-HNS) Consultant ENT surgeon, Leeds Teaching Hospitals, Leeds, Yorkshire, United Kingdom.

Aim There is increasing evidence of insufficient surgical education in the medical curriculum and a growing sentiment amongst medical students of poor confidence in the operating room (OR). Near-Peer Teaching (NPT) has emerged as a common pedagogical solution utilising cognitive congruence to counter this, whereby senior medical students and recent graduates are recruited as near-peer tutors. We aim to review the successes and areas for improvement in the current literature. Method A comprehensive literature search was performed on EMBASE, PubMed and MedLine. Results Pre-post questionnaire comparison from a NPT-led surgical skills course reported significantly increased self-perceived confidence in performing some of 8 surgical domains. Providing basic surgical skills in conjunction with 'Flipped Classroom' yielded significantly higher confidence in performing all sutures and knot-ties assessed. Another workshop had medical students achieve double the number of sutures and improved suturing technique post-session. Increased confidence in surgical skills and OR were additionally achieved through a NPT-led OR simulating environment. NPT-led surgical and clinical anatomy courses equipped students with higher confidence and comfort assisting in the OR. Commonly, the informal, perceived 'low-risk' kinaesthetic environment is described to ease feelings of anxiety and be conducive to surgical education. NPT furthermore reported benefits for instructors pertaining to self-efficacy, teaching skills, surgical confidence, and knowledge consolidation. Conclusions NPT enhances surgical career interests and improves outcomes of surgical education for both tutors and tutees, when delivered in addition to surgical teachings in the curriculum. The design of NPT and training of tutors however, ought to be supervised by a senior surgical staff.

As surgical education has evolved, most curricula have favoured a competency-based approach over traditional apprenticeship models. Surgical simulation can be a useful aide in the training of both oncological and reconstructive breast surgery trainees. This review investigates the extent to which simulation of breast surgery procedures has been validated as a training tool. A comprehensive literature search for studies evaluating the objective validity of breast surgery simulators was performed, using MEDLINE, EMBASE and the Cochrane Library databases. Studies assessing construct, concurrent or predictive validity were included, as well as those demonstrating skill acquisition. The initial literature search returned 1,625 hits, with only five articles meeting the inclusion criteria. Simulators were designed to train procedures such as breast augmentation, lesion biopsy and excision. Of these, breast biopsy was the most simulated procedure (three studies). Two studies evaluated animal models, two evaluated synthetic models and one study assessed both a synthetic and animal model. Construct validity was confirmed in two studies, concurrent validity in one study and a learning curve demonstrated in another study. No association between experience and performance was seen in the remaining study. The quality of the evidence presented in each article was low due to numerous limitations. Despite the abundance of breast surgery simulators created for trainees, few have been objectively validated and they only cover a narrow range of breast procedures. Although early results are promising, further studies are required before routine use of simulators is considered in breast surgery curricula.

PurposeVirtual reality (VR) has emerged as a transformative tool in surgical education, offering a controlled and repeatable training environment that mitigates ethical and legal challenges associated with traditional apprenticeship models. By simulating real-life surgical scenarios, VR allows trainees to practice procedures safely while improving skill acquisition and procedural efficiency. In this study, we systematically reviewed research trends in VR-based surgical education to provide insights into its current applications and future potential.MethodsA comprehensive literature search was conducted on PubMed, identifying 395 studies. Of these, 92 studies met predefined inclusion criteria and were selected for analysis. The selected studies were analyzed based on publication period, surgical procedure, medical specialty, country of origin, and outcome measures.ResultsStudy findings revealed that research on VR surgical simulation peaked between 2005 and 2009, followed by a decline in recent years. Laparoscopic and endoscopic training were the most frequently studied procedures, with general surgery and gastroenterology being the most predominant specialties. The United States contributed the highest number of publications. Common outcome measures for evaluating VR training effectiveness included time, movement economy, subject evaluation, error rates, proficiency scales, and accuracy.ConclusionThese findings illustrate the historical trajectory and current landscape of VR use in surgical training. While the initial surge in interest has waned, VR remains a valuable tool for procedural skill development, particularly in laparoscopic and endoscopic training, and its future potential may depend on improvements in realism, cost-efficiency, and curriculum integration.

BackgroundThe acquisition and maintenance of technical skills in surgical specialties has become increasingly challenging for postgraduate trainees, exacerbated by factors such as the shift from traditional apprenticeship models, reduced operative time, and the impact of the COVID-19 pandemic. Virtual reality (VR) simulators offer a promising adjunct to traditional surgical training, though their integration into routine practice remain underexplored.ObjectiveThis qualitative study investigates the experiences and motivations of general surgical trainees who engaged with a VR laparoscopic simulator as part of a structured training program.MethodsA case study methodology was chosen to explore the experiences of 22 general surgery trainees using a VR laparoscopic simulator over a period of 3 months. Each of the trainees were adviced to practise a minimum of five repetitions across 25 laparoscopic simulator exercises. The study was designed using Kopta’s theory of technical skill learning, focusing on the cognitive phase, where trainees repetitively practised individual steps with feedback. Data collection involved qualitative questionnaires, semi-structured interviews (of seven of the trainees, 8 months later), and quantitative data from the simulator. The qualitative data was analysed using thematic analysis, and descriptive statistical tests were applied to the quantitative data for triangulation.ResultsThe study identified key factors influencing trainee engagement, including ease of access, the importance of periodic rather than frequent simulation sessions, Annual Review of Competency Progression (ARCP) overview and the value of setting specific performance goals. The findings suggest that simulation can effectively complement traditional surgical training when incorporated into routine practice, with potential for broader application if barriers such as time constraints and access issues are addressed.ConclusionThis study contributes to the literature on surgical education by highlighting the need for targeted strategies to enhance the use of simulation as an adjunct alongside more traditional training.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41077-025-00359-x.