Surgical mentorship in low-resource environments: Opportunities and challenges, a perspective

Generalizability of Artificial Intelligence Assessments in Laparoscopic Surgery Simulation

INTRODUCTION

The application of artificial intelligence (AI) in the assessment of procedural skills on a simulation platform using the global rating scale (GRS) has shown promise. Our team developed an open-source, low-cost simulation platform for the development of laparoscopic skills in low-resource settings, with skill assessment provided by video-based peer review and AI. The generalizability of AI trained on one procedure to evaluate general procedural skills within a single training system is unknown. This study examines the feasibility of generalizing AI-based assessments across procedures in a training system.

METHODS

AI was trained, with varied combinations of procedures, to score 111 laparoscopic performance videos of four procedures (57 salpingostomies, 20 appendectomies, 15 enterectomies, and 19 diaphragmatic repairs), using time and distance-based calculations. Predicted scores were generated using five-fold cross-validation and K-nearest neighbors, with both 5-class (scored 1-5) and 2-class (pass/fail) scoring systems. Videos were also scored in a conventional fashion using human video-based review, based on GRS competencies.

RESULTS

AI assessments achieved 42%-100% concordance with human reviews in the 5-class system and 68%-100% in the 2-class system, P = 0.005. Within the 5-class system, 100% accuracy was reached when AI trained on multiple procedures evaluated appendectomy. The 2-class system attained 100% accuracy in three procedures across the GRS competencies.

CONCLUSIONS

AI assessment trained on procedures using video-based review evaluated laparoscopic skills across different procedures within a simulation-based training system. Dichotomizing scoring to pass/fail improved accuracy, while supporting the potential to assess procedural competence.

Challenges in early career for HPB surgeons: an international practice survey

BACKGROUND

Understanding the needs of early-career surgeons is essential for developing strategies for support. This study examined perceived needs of early-career HPB surgeons worldwide.

METHODS

A self-administered web-based survey of early career HPB surgeons (aged ≤45 years old or practicing for ≤5 years) was conducted. A questionnaire was developed through items generation and reduction, followed by pilot testing. Quantitative data were reported with descriptive statistics and qualitative responses analysed using open coding.

RESULTS

There were 282 respondents. Six main areas of challenges were identified: mentorship opportunities, continued skills acquisition and training, research and collaboration, leadership and career development, clinical knowledge exchange, and accessibility including financial barriers. Specifically, highest rated challenges were ebalancing work and personal life (mean 6.98, SD 2.92), research (mean 6.79, SD 2.50), career development/mentorship (mean 6.70, SD 2.30), networking/collaboration (mean 6.16, SD 2.71), leadership and (mean 6.09, SD 2.53). Rating of research as a challenge was higher in Africa and Central/South America (p = 0.01), and that of leadership was higher in Asia, Oceania, and the Middle East (p = 0.02).

CONCLUSIONS

This survey highlights the multiple challenges faced by early-career HPB surgeons worldwide. These results provide insights into how to better support early-career HPB surgeons to fully develop their specialty.

Medicine Meets Science: The Imperative of Scientific Research and Publishing for Physician-Scientists

Physician-scientists serve as conduits between clinical practice and scientific research, leveraging their unique expertise to improve patient care and drive medical innovation. This article highlights the indispensable role of research and publishing in promoting evidence-based practices, facilitating professional growth, and shaping public health policy. Drawing on historical and contemporary examples, I examine the challenges faced by physician-scientists, such as ethical dilemmas and declining engagement in research, particularly in resource-constrained settings. I suggest pragmatic strategies to overcome these barriers, emphasizing the need for systemic support, ethical integrity, and the equitable dissemination of advancements. This piece aims to inspire a new generation of physician-scientists to engage deeply with both clinical and research domains, thus advancing global health equity and resilience.

Surgical Training Pathways in the United Kingdom and the United States: Lessons for Resource-Limited Settings From High-Income Countries

Background Surgical training is a critical component of healthcare, especially in high-income countries such as the United Kingdom (UK) and the United States (US), which have established distinct, well-organised training frameworks. Comparing these systems provides valuable insights that may enhance global surgical education, particularly in low- and middle-income countries, where training and retaining proficient surgeons are considerable challenges. Methodology This comparative study examines the surgical training systems in the UK and the US, focusing on key aspects, including training structure, competency-based assessments, and work-hour regulations. Data were sourced from regulatory organisations such as the General Medical Council, the Royal College of Surgeons, the Accreditation Council for Graduate Medical Education, and the American Board of Surgery. The analysis explores how elements of these models might be adapted to support sustainable surgical education frameworks in resource-limited environments. Ethical approval was not required due to the use of publicly accessible data and no patient involvement. Results The UK and US surgical training systems differ substantially in their structure, training duration, and specialisation timing. The UK employs a tiered approach, offering generalist experience before specialisation, while the US favours early specialisation directly after medical school. Both systems implement competency-based evaluations, though the US system places a greater emphasis on case volume and procedural exposure. Work-hour regulations also vary, with the UK capping weekly hours at 48 under the European Working Time Directive, compared to an 80-hour maximum in the US, which results in differing levels of trainee satisfaction and burnout rates. Conclusions The competency-based assessments in both the UK and the US offer adaptable frameworks for resource-limited settings. The phased training approach in the UK is well-suited for environments requiring versatile surgeons capable of handling a wide range of cases. By implementing these adaptable elements, along with cost-effective training innovations such as simulation tools, e-learning platforms, and international partnerships, resource-constrained regions can foster a sustainable, skilled surgical workforce. These insights offer pathways to improve healthcare outcomes and equity globally by enhancing surgical capacity in regions with limited resources.