What can surgery learn from other high-performance disciplines?

The Future of Artificial Intelligence in Surgery

Until recently, innovations in surgery were largely represented by extensions or augmentations of the surgeon's perception. This includes advancements such as the operating microscope, tumor fluorescence, intraoperative ultrasound, and minimally invasive surgical instrumentation. However, introducing artificial intelligence (AI) into the surgical disciplines represents a transformational event. Not only does AI contribute substantively to enhancing a surgeon's perception with such methodologies as three-dimensional anatomic overlays with augmented reality, AI-improved visualization for tumor resection, and AI-formatted endoscopic and robotic surgery guidance. What truly makes AI so different is that it also provides ways to augment the surgeon's cognition. By analyzing enormous databases, AI can offer new insights that can transform the operative environment in several ways. It can enable preoperative risk assessment and allow a better selection of candidates for procedures such as organ transplantation. AI can also increase the efficiency and throughput of operating rooms and staff and coordinate the utilization of critical resources such as intensive care unit beds and ventilators. Furthermore, AI is revolutionizing intraoperative guidance, improving the detection of cancers, permitting endovascular navigation, and ensuring the reduction in collateral damage to adjacent tissues during surgery (e.g., identification of parathyroid glands during thyroidectomy). AI is also transforming how we evaluate and assess surgical proficiency and trainees in postgraduate programs. It offers the potential for multiple, serial evaluations, using various scoring systems while remaining free from the biases that can plague human supervisors. The future of AI-driven surgery holds promising trends, including the globalization of surgical education, the miniaturization of instrumentation, and the increasing success of autonomous surgical robots. These advancements raise the prospect of deploying fully autonomous surgical robots in the near future into challenging environments such as the battlefield, disaster areas, and even extraplanetary exploration. In light of these transformative developments, it is clear that the future of surgery will belong to those who can most readily embrace and harness the power of AI.

Protocol for a scoping review on 'surgical sabermetrics:' technology-enhanced measurement of operative non-technical skills

INTRODUCTION

Surgeons need high fidelity, high quality, objective, non-judgemental and quantitative feedback to measure their performance in order to optimise their performance and improve patient safety. This can be provided through surgical sabermetrics, defined as 'advanced analytics of digitally recorded surgical training and operative procedures to enhance insight, support professional development and optimise clinical and safety outcomes'. The aim of this scoping review is to investigate the assessment of surgeon's non-technical skills using sabermetrics principles, focusing on digital, automated measurements that do not require a human observer.

METHODS AND ANALYSIS

To investigate the current methods of digital, automated measurements of surgeons' non-technical skills, a systematic scoping review will be conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, using databases from medicine and other fields. Covidence software is used for screening of potential studies. A data extraction tool will be developed specifically for this study to evaluate the methods of measurement. Quality assurance will be assessed using Quality Assessment Tool for Diverse Designs. Multiple reviewers will be responsible for screening of studies and data extraction.

ETHICS AND DISSEMINATION

This is a review study, not using primary data, and therefore, ethical approval is not required. A range of methods will be employed for dissemination of the results of this study, including publication in journals and conference presentations.

Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training

Shared mental models between surgeons and nurses allow them to effectively communicate and react to intraoperative complications. Microsurgery poses unique challenges that include the use of an operating microscope, fine instruments, and a restricted view of the operative field. We designed and delivered a microsurgical skills session for surgical nurses consisting of an introduction to the operating microscope and 3 practical stations involving increasingly complex motor tasks designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub persons to add an element of role-reversal. All participants enjoyed the training session and felt that it improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees reported that they would partake in similar sessions in the future. Our work suggests that role-reversal and skills-based education and training are valuable tools in improving multidisciplinary collaboration during microsurgery. Increasing shared knowledge of complex procedures encourages effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step toward development of a standardized microsurgical skills course for plastic surgical nurses and has broader implications for interprofessional education across all surgical specialties.

The use of educational technology for interactive teaching in lectures

Students often feel overwhelmed by the volume and complexity of knowledge and skills required to learn. Along with this challange, educational technology has been gradually introduced in medical education to facilitate learning and improve outcomes. It became an essential part of communication, storing and transferring information, audio-visual media use and production, and knowledge sharing. Technology's role has been expanding from a mere tool of study and inquiry to an approach and integrated use in education. Its use in medical education is continuously evolving. However, the impact and optimal use of various technology applications are not clearly defined. There are multiple challenges facing educators to choose the right application for the specific educational purpose. Hence, studies and evaluation reviews are needed to inform the better-defined use of educational technology. This review aims to discuss and evaluate various educational technology applications in medical education, focusing on interactive learning during lectures. Lectures and other group learning sessions are common activities used by medical schools. Promoting interactive learning in large groups is known to be challenging. The advances in technology to facilitate communication and promote interaction is a promising adjunct for lectures interactivity.

Alternatives surgical training approaches during COVID-19 pandemic

Importance

Coping with the COIVD-19 global-pandemic major changes in healthcare and educational operational policies, mandates the implementation of alternative surgical curriculum objects (components) to replace some of the traditional face-to-face activities.

Objective

The objective of the study is to review and discuss various alternative curriculum objects (components) that can be used to restructure conventional surgical training curricula during the Declared Healthcare Emergency surgery rotations. The goal is to identify and recommend effective alternative educational activities that are compliant with the new social physical distancing regulations.

Evidence review

Various curricular components and objects were examined. The educational value of the curriculum objects is studied and analyzed in terms of feasibility, knowledge gain/learning effectiveness, the need for facilitation or feedback, and the evaluation. Several curriculum objects were proposed with description of their value and applications.

Findings

The selected and proposed activities include scenario-based MCQ writing exercises, video-based surgical skills interactive training, online learning modules, virtual rounding, reflection assignments, surgical skills simulation training, research education, and medical education learning. Their educational value is described and scaled.

Conclusion

There is urgent and challenging need for surgical training using additional alternative curriculum objects (components). Working with the available resources and experiences is crucial to maximize the learning outcomes. Distance (online) education and educational technology tools and concepts provide a spectrum of valuable educational activities. Further work and studies are needed to optimize their utility.

•

The COIVD-19 pandemic has imposed major changes in healthcare and educational operational policies.

•

This review discusses alternative curriculum objects that can be used to restructure traditional surgical training curricula.

•

Effective alternative educational activities that are compliant with the social distancing regulations were discussed.