Over the past 50 years the capability of technology to improve surgical care has been realised and while surgical trainees and trainers strive to deliver care and train, the technological ‘solutions’ market continues to expand. We have reached a pivotal point in the digital transformation of surgical training, and it is in this context that the Future of Surgery: Technology Enhanced Surgical Training (FOS:TEST) Commission was launched.
The FOS:TEST Commission was formed by the Association of Surgeons in Training (ASiT), The Royal College of Surgeons of England (RCS England) Robotics and Digital Surgery Group and representatives from all trainee specialty and college associations. Its mission has been to identify unmet surgical training needs, map these to the patient and trainee pathway, and discover potential technological solutions.
For future UK and ROI surgeons to stay relevant in a global market, our training methods must adapt. The Future of Surgery: Technology Enhanced Surgical Training Report provides a blueprint for how this can be achieved. It requires academic expertise and collaboration to evaluate efficacy of any novel training solution, coupled with pragmatic assessments of feasibility and cost to ensure that any intervention is scalable for national implementation. While there is no replacement for hands-on operating, several novel surgical innovations offer promise as technology enhanced adjuncts to traditional training approaches.
The Technology Enhanced Surgical Training Report was commissioned in order to define unmet needs in surgical training and understand how technological advancements can be implemented to better care for patients.
Key Recommendations
Technology enhanced training solutions with evidence to demonstrate educational effectiveness should be considered for integration into surgical training. These should augment and not replace hands-on training.
Technology enhanced training solutions need to be sufficiently resourced and made available equitably, ensuring they are mapped to the unmet needs of surgical trainees and trainers from all specialties across the UK and Republic of Ireland.
Trainees and trainers require training in the use of technologies (including digital literacy and proficiency, the fundamentals and potential applications of artificial intelligence and imaging-based diagnostics, prognostic modelling methods, genomics and digital consent) to ensure that they can take advantage of the potential to enhance future care delivery for patients.
Stronger collaboration is required between technology providers and surgical training stakeholders to ensure that any future assessment of competence, benchmarking and training metrics are standardised and mapped to curricula. Collaboration should seek to avoid duplication of frameworks, curricula and guidance.
A clear educational outcomes framework for the assessment and adoption of surgical training interventions is needed for the benefit of patients, trainees, trainers and technology providers.
Research initiatives should be established to bring coherence to the investigation and gathering of evidence. Promising or early developments that should be prioritised include: the feasibility of video and image database technology to produce a virtual logbook; the acceptability of wearable devices in surgery for patients, trainees and trainers; the views of patients, trainees and trainers on the use of training case recordings; the use of immersive technology and virtual platforms in workplace-based assessments; and the need for a core, pre-procedural robotics curriculum.
The ethical considerations of any technology with the potential to enhance surgical training must be explored to ensure that patients are safeguarded and are not disadvantaged by its use.
TEST Commission members
Mr Oliver Adebayo
President, British Orthopaedic Trainees Association (BOTA)
Mr Abdul Badran
Trainee Representative, Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS)
Dr Will Bolton
Past Innovation Lead, Association of Surgeons in Training (ASiT)
Mr Josh Burke
Chair, FOS:TEST Commission
Ms Charlotte El-Sayed
Digital Fellow, Health Education England
Ms Tamara Gall
Robotics Representative, Roux Group
Mr Manish George
Past President, Association of Otolaryngologists in Training (AOT)
Ms Lolade Giwa-Brown
Past President, Association of Surgeons in Training (ASiT)
Ms Francesca Guest
ASiT Representative, Rouleaux Club
Ms Deena Harji
RCS England Robotic and Digital Surgery Trainees Group
Mr Neil Harvey
President, BAUS Section of Trainees (BSoT)
Ms Natasha Jiwa
Chair, Mammary Fold
Ms Natasha Keates
Past Vice-President, Association of Surgeons in Training (ASiT)
Mr Martin King
President, Association of Surgeons in Training (ASiT)
Mr Mark Mikhail
Innovation Lead, Plastic Surgery Trainees Association (PLASTA)
Mr Omar Nasher
Past Chair, Trainees in Paediatric Surgery (TriPS)
Mr Michael Okocha
Equality and Diversity Officer, Association of Surgeons in Training (ASiT)
Mr Anand S Pandit
Digital Surgery Representative, British Neurosurgical Trainees Association (BNTA)
Mr Ricci Plastow
RCS England Robotic and Digital Surgery Trainees Group
Mr Haroon Rehman
Chair, RCS Edinburgh Trainees Committee
Ms Catherine Wicks
Representative, British Association of Oral and Maxillofacial Surgery Fellows in Training (OMFS FiT)
