Surgical Education: Principle and Practice for the Future

Training must evolve as duty-hour restrictions and advances in scientific knowledge continue to challenge surgical residents. Adult learning theory offers a framework to help surgical education programs improve their training processes. One such model is a remote learning model incorporating video-based training and face-to-face instruction.

Principles

Surgical education is expensive and complex, with many factors influencing curriculum development, learning methods, opportunities, and stakeholders. Despite this complexity, the need for competent surgeons is increasing.

Moreover, with the advent of duty-hour restrictions, training programs must continue to adapt to accommodate these constraints. This has led to development of new techniques and approaches for training surgeons.

The principles of surgical education are based on didactic, experiential learning and structured skill training. They are foundational to trainees’ learning and help shape their ability to think critically and make good decisions during practice.

During surgical training, students learn to perform surgery by direct observation and imitation. They also receive guidance from skilled mentors in the operating room and onwards.

Practice

Surgical education techniques need to evolve to meet the rapidly evolving demands of contemporary practice. This is due to the emergence of artificial intelligence (AI) and robotics, as well as the changing demographics and workforce needs of trainees.

Training programs also face the challenge of duty hour restrictions and increasing workloads. These changes have reduced the time that trainees can develop expertise and increased the need for more efficient, effective training strategies.

The UCSF Department of Surgery is working to address these challenges with various research projects and curricular options. We are in an excellent position to lead this important area of educational research and to continue to be a national leader in surgical education.

Introducing a structured introductory surgical component to the medical curriculum is essential for preparing future surgeons to become subspecialists and ensuring that all possible surgical faculty can be prepared to deliver effective clinical care. Currently, only about 70% of male and 50% of female residents who complete general surgical residency go on to a specialty.

Research

Surgical education research is rapidly growing, and UCSF is positioned to lead this work. Our faculty are conducting cutting-edge research that is having an impact on surgical training programs worldwide.

Our research focuses on the cognitive aspects of learning skills. In particular, we use lessons from metacognition to optimize the training process on a personal level to accelerate an individual’s growth into expertise.

The classic S-shaped learning curve illustrates how an individual gains proficiency through experience (Figure 1). It begins with a steep phase of foundational knowledge that allows an individual to mature and gain skills quickly. This phase is followed by a plateau at which additional experience leads to only incremental improvements.

A new model for surgical education must shift the learning curve to the left and steepen it to enable trainees to achieve fluency with fewer iterations in real-world scenarios. This requires changes to credentialing, assessment, and accreditation systems and a more time-variable, competency-based medical education system.

Ethics

The ethics of surgical education is an important aspect that should be taught throughout medical school and extended into residency. It focuses on the ethical implications of surgery, such as unnecessary surgery, futile surgery, surgical treatment for terminal patients and the use of new technologies.

During surgical training, trainees are exposed to the work of more experienced teachers and attend a variety of operations as assistants. However, the ethical responsibilities of surgeons extend beyond the operating room and include hospital rounds and ambulatory care.

The COVID-19 pandemic has brought many challenges to surgical education, limiting training opportunities that previously allowed residents to learn hands-on. Duty hour restrictions resulting from this have negatively impacted learning progress, and the future of surgical resident training requires re-envisioning to address these challenges.