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Analysis shows adopting new technology is vital to surgeons’ training

08 Aug 2022

The Association of Surgeons in Training (ASiT) and The Royal College of Surgeons of England have today set out in a joint report how accessing new technology could transform surgeons’ training and improve patient care.

The Future of Surgery: Technology Enhanced Surgical Training (FOS:TEST) Commission received over 120 evidence submissions from surgeons in training, consultant surgeons and training leaders. Following peer review, 32 were selected covering a range of innovations, from how 3D printing, or surgical video and image databases, might enhance surgical education, to genomics and wearable technology in surgical training.

The pandemic highlighted shortcomings in surgical training programmes and shone a light on inefficiencies and barriers for both trainees and trainers. The Commission found that more than 1.5 million fewer operations have involved a trainee surgeon than in equivalent periods before the pandemic.  Up to 35% of trainees have already had their training extended or put at risk of extension because of the impact of COVID-19. The final report, The Future of Surgery: Technology Enhanced Surgical Training (FOS:TEST), calls for technology-enhanced surgical training to form part of the solution to these challenges. However, it also warns that there is no co-ordinated process to assess new technologies. It calls for national frameworks to ensure innovations in surgical training are introduced in a coherent and equitable way across the country.

The report highlights how there is increasing adoption of robotic surgery in clinical consultant work - but fewer than 30% of surgical trainees are gaining access to the required literacy and skills to deliver robotic surgery.

The FOS:TEST report, makes seven recommendations on how to enhance surgical training through the wider adoption and dissemination of technology.

It states: “At present, there is no replacement for hands-on operating. However, for future surgeons in the UK and Republic of Ireland to stay relevant in a global market, our training methods must adapt.” The report provides a blueprint for how this can be achieved.

The report’s seven recommendations include:

  • 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.

  • 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.

This Commission’s report follows the RCS England’s Future of Surgery report from 2018. It predicted developments in robotics, artificial intelligence, genomics, and digital technologies - promising a future where healthcare is even less invasive and much more personalised.

Mr Josh Burke is Chair of the FOS:TEST Commission and a General Surgery Registrar. He coordinated the review following his experience as President of The Association of Surgeons in Training. Mr Burke said:

“There has never been a more crucial time to be proactive in our approach to training surgeons.  Unfortunately, the NHS waiting list for planned hospital treatment is at a record high and there are continued deficits in training surgeons’ logbook numbers. Up to 35% of trainees have already had their training extended because of the impact of COVID-19. This impact is evident across all areas of training, but is seen most clearly in the acquisition of technical skills through exposure to supervised operating. While surgical trainees and trainers strive to deliver care and train at the same time, technology continues to advance.

“Academic expertise and collaboration will be required to evaluate efficacy of any new training method. However, this must be coupled with pragmatic assessments of feasibility and cost to ensure that any intervention is scalable for national implementation.”

Miss Esther McLarty, a Council Member of the Royal College of Surgeons of England and Chair of the Confederation of Postgraduate Schools of Surgery, said:  

“This report clearly shows that technology-enhanced surgical training should form part of the solution to the challenges surgeons in training face.  Although technology-enhanced training will never replace real, hands-on experience, it is an important addition to training. More than 1.5 million fewer operations have involved a trainee than in equivalent periods before the pandemic. Trainees need to be helped back on a normal training path as quickly as possible, to ensure they develop their technical skills.

Mr Richard Kerr, Chair of the Future of Surgery Commission, said:

“This report provides a detailed review of the way our surgeons and surgical teams of the future could be trained, and how this can be improved using all the advances in technology.  It is aimed at those who are involved in the delivery of training as well as those who will undertake that training. Ultimately it is also aimed at patients, whose care we are dedicated to improving.”


Notes to editors

1. The full report is available here:

2. The Commission on the Future of Surgery: Technology Enhanced Surgical Training (FOS:TEST) was formed by the ASiT and the Robotics and Digital Surgery Group of The Royal College of Surgeons of England.

3. The Association of Surgeons in Training (ASiT) is an independent professional body and charity who supports over 4,500 members advocating for the very best in surgical training in the UK, ROI and beyond.

4. The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance patient care. It supports over 28,000 members in the UK and internationally by improving their skills and knowledge, facilitating research and developing policy and guidance.  

5. For more information, please contact the RCS England Press Office:

  • Telephone: 020 7869 6052/6055
  • Email:
  • For out-of-hours media enquiries, please telephone: 020 7869 6056

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