The Evolving Landscape of Surgical Competency in the Age of Artificial Intelligence and Technology-Enhanced Learning

Mohamed A. Imam, MD, MSc, DSportMed, ELD (Oxon), PhD, FRCS, UNITED KINGDOM Margaret W. M. Fok, FRCSEd(Ortho), MBChB, HONG KONG

ISAKOS eNewsletters   Current Perspective 2025   rating (1)

Competency in surgical practice has always been more than just acquiring a set of skills; it is an ongoing journey of continuous learning, mastery, and refinement. Traditionally, this journey has been shaped by rigorous training, hands-on experience, and a commitment to lifelong education. However, as we move further into the 21st century, the landscape of surgical competency is undergoing a profound transformation, driven by the rapid advancements in artificial intelligence (AI) and technology-enhanced learning. At the recent ISAKOS meeting in Boston, the importance of AI in orthopaedics was a major focus, with numerous sessions dedicated to exploring how these technologies are revolutionizing the field. These discussions highlighted the growing recognition that AI and digital tools are not just supplements to traditional methods but are becoming integral components of surgical education and practice¹.

AI has the potential to reshape every aspect of surgical training and practice. From personalized learning modules that adapt to the specific needs of individual surgeons, to advanced simulation platforms that provide realistic, risk-free environments for honing skills, technology is enabling a more tailored and effective approach to developing surgical competency. These tools allow for a deeper understanding of complex procedures, real-time feedback during surgery, and the ability to simulate rare or difficult cases that might otherwise be encountered infrequently.

Furthermore, technology-enhanced learning is providing new ways for surgeons to maintain and enhance their skills throughout their careers. With AI-driven analytics, surgeons can continuously assess their performance, identifying areas for improvement and adjusting their practice accordingly. This level of insight was unimaginable just a decade ago and is now becoming a critical aspect of modern surgical education².

As we stand on the cusp of this new age in medicine, it is crucial to reflect on what these innovations mean for the future of surgical education and patient care. The integration of AI and advanced technologies is not merely about adopting new tools; it is about fundamentally rethinking how we achieve and maintain surgical competency. It challenges us to consider how these technologies can be harnessed to improve outcomes, reduce errors, and ensure that every surgeon is equipped with the skills and knowledge necessary to provide the highest standard of care.

The future of surgical practice lies in the effective integration of these technological advancements with the time-honored principles of medical education. As AI continues to evolve, it will likely play an even greater role in shaping the next generation of surgeons, offering opportunities for more precise, data-driven approaches to both training and clinical practice. However, this future also demands that we remain vigilant about the ethical implications, ensuring that technology enhances, rather than diminishes, the human elements of care, compassion, and judgement that are at the core of surgical practice.

The Traditional Stages of Competency

Traditionally, surgical competency has been understood as a progression through four psychological stages:

1. Unconscious Incompetence: The novice is unaware of what they do not know—a stage during which ignorance is often bliss but also dangerous.
2. Conscious Incompetence: The realization dawns that there is much to learn, motivating the pursuit of knowledge and skill development.
3. Conscious Competence: Skills are acquired and can be performed competently, although they require focused effort and concentration.
4. Unconscious Competence: Mastery is achieved; the surgeon can perform procedures effortlessly, with skill becoming second nature.

Fig. 1 The four stages of competency.

Self-Awareness and the Dunning-Kruger Effect

In today’s fast-paced world, self-awareness is more crucial than ever. The Dunning-Kruger Effect reminds us that a little knowledge can sometimes lead to overconfidence, while true expertise often brings humility. As professionals, it’s important to continuously seek feedback, question our assumptions, and commit to lifelong learning. By recognizing the limits of our knowledge, we grow as individuals and enhance the value that we bring to our teams and organizations. This principle is particularly relevant in the integration of AI and technology-enhanced learning, wherein the balance between confidence in new tools and humility in recognizing their limitations is key to maintaining surgical excellence³.

Fig. 2 The Dunning-Kruger Effect

However, as we integrate AI and advanced technologies into surgical training, a fifth stage—Technologically Enhanced Competence—emerges. This stage acknowledges the role of AI and digital tools in supporting, enhancing, and extending the surgeon’s capabilities beyond traditional human limitations.

The Role of AI in Surgical Training and Competency

Artificial intelligence is not just a tool; it is becoming a partner in the surgical suite. AI-driven platforms are now capable of analyzing vast amounts of surgical data, providing real-time feedback, and offering predictive insights that can guide decision-making during complex procedures. For example, AI can highlight potential complications based on patient-specific data, suggest optimal surgical paths, and even predict outcomes with a high degree of accuracy.

In the context of surgical training, AI can revolutionize how we progress through the stages of competency:

• Personalized Learning: AI can tailor learning experiences to the individual surgeon’s needs, identifying specific areas of weakness and providing targeted training modules. This customized approach ensures that no competency gap is overlooked⁴.
• Simulation and Augmented Reality (AR): Technology-enhanced learning tools such as surgical simulators and AR platforms allow trainees to practice procedures in a risk-free environment. These simulations can be tailored to mimic rare or complex cases, providing invaluable experience that would otherwise be difficult to obtain².
• Continuous Monitoring: AI systems can continuously monitor a surgeon’s performance, tracking metrics such as precision, speed, and decision-making under pressure. This data-driven approach allows for ongoing assessment and adjustment of training programs to ensure that surgeons remain at the peak of their abilities⁵.

The Challenges and Opportunities of AI in Surgical Practice

While AI and technology-enhanced learning offer tremendous opportunities, they also present new challenges. One significant concern is the potential for over-reliance on technology, which could lead to a decline in fundamental surgical skills. As AI takes on more routine tasks, surgeons must be vigilant in maintaining their core competencies, ensuring that technology serves as an enhancement rather than a crutch.

Moreover, as AI systems become more integrated into surgical practice, ethical considerations around decision-making and patient consent will need to be addressed. Surgeons must remain the final authority in the operating room, with AI serving as a support tool rather than a decision-maker.

The Fifth Stage: Technologically Enhanced Competence

As we incorporate AI and advanced technologies into surgical practice, we must recognize that these tools are not a replacement for human skill but an enhancement of it. The fifth stage of competency—Technologically Enhanced Competence—reflects a new reality in which surgeons leverage AI and digital tools to push the boundaries of what is possible in surgery.

This stage requires a deep understanding of both traditional surgical techniques and the new technologies that augment them. Surgeons must be proficient in using AI-driven platforms, interpreting data provided by these systems, and integrating this information into their surgical decision-making process.

Maintaining Competency in the Age of AI

In this evolving landscape, maintaining competency requires a commitment to lifelong learning and adaptation. Surgeons must stay abreast of the latest technological advancements and continuously seek opportunities to integrate these tools into their practice. This may involve regular training on new AI platforms, participation in simulation exercises, and engagement with interdisciplinary teams that include data scientists and AI specialists. At the same time, it is crucial to remember that the fundamentals of surgery—critical thinking, manual dexterity, and patient-centered care—remain as important as ever. Technology should enhance these skills, not replace them.

In light of the rapid advancements in AI and technology, the training of surgeons must evolve to ensure proficiency in these emerging tools. The Royal College of Surgeons in England has emphasized the necessity for both trainees/residents and trainers to engage with technology to fully leverage its potential. This includes incorporating AI into the curriculum, not only as a tool for learning but as an integral component of surgical practice.

To ensure that surgeons are adequately prepared for the demands of modern practice, it is recommended that surgical education programs focus on the following key areas:

1. Enhanced Technology Training: Surgeons must be trained to effectively use AI-driven tools and digital platforms that are increasingly becoming central to patient care. This includes the ability to interpret complex data and integrate AI insights into clinical decision-making.
2. Continual Professional Development: Surgeons should commit to lifelong learning that includes regular updates on the latest technological advancements. This might involve workshops, simulation exercises, and interdisciplinary collaboration with technology experts.
3. Ethical and Practical Integration: As AI becomes more prevalent, it is crucial that surgeons are educated on the ethical implications of these technologies. They must understand how to balance technological assistance with human judgment, ensuring that AI enhances rather than diminishes the quality of patient care.
4. Supportive Training Environment: Trainers must also be equipped with the necessary skills to teach these new competencies. This includes being well-versed in the latest technologies and capable of guiding trainees through the process of integrating these tools into their practice.

Conclusions

The future of surgical education lies in creating a symbiotic relationship between traditional surgical skills and advanced technological capabilities. As the Royal College of Surgeons highlights, the goal is to ensure that every surgeon is not only skilled with the scalpel but also proficient in using the tools of the 21st century to deliver the highest standards of care. Integrating AI and technology-enhanced learning into surgical practice marks a new era in the competency journey. As we embrace these innovations, we must do so with a clear understanding of their potential and limitations. The future of surgery lies not just in mastering the scalpel but in learning the technologies that will define the next generation of surgical practice.

By acknowledging the fifth stage of competency—Technologically Enhanced Competence—we prepare ourselves for a future where AI and human skills work hand in hand to achieve the highest standards of patient care. The challenge for today’s surgeons is to navigate this new landscape with a commitment to excellence, ensuring that we continue to deliver safe, effective, and compassionate care in the age of AI.

References

1. Thomas WE. Teaching and assessing surgical competence. Ann R Coll Surg Engl. 2006;88(5):429-32.
2. Khoriati AA, Shahid Z, Fok M, Frank RM, Voss A, D'Hooghe P, et al. Artificial intelligence and the orthopaedic surgeon: A review of the literature and potential applications for future practice: Current concepts. J isakos. 2024;9(2):227-33.
3. Prozesky DR, Molwantwa MC, Nkomazana O, Kebaetse MB. Intern preparedness for the CanMEDS roles and the Dunning-Kruger effect: a survey. BMC Med Educ. 2019;19(1):422.
4. Bekbolatova M, Mayer J, Ong CW, Toma M. Transformative Potential of AI in Healthcare: Definitions, Applications, and Navigating the Ethical Landscape and Public Perspectives. Healthcare (Basel). 2024;12(2).
5. Constable MD, Shum HPH, Clark S. Enhancing surgical performance in cardiothoracic surgery with innovations from computer vision and artificial intelligence: a narrative review. J Cardiothorac Surg. 2024;19(1):94.

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