Teaching methods used by general surgeons in simulation or formative assessment leading to improved surgical skill acquisition in UK surgical trainees: a scoping review

Background: The UK general surgery (GS) training faces challenges despite curriculum reforms, this includes varied teaching quality, limited simulation teaching, reduced training opportunities and curriculum flaws. Recent national surveys highlight discrepancies between GS trainees’ dissatisfaction in comparison to other specialities. The aim is to identify teaching methods in simulation or formative assessment leading to improved surgical skill acquisition in GS. Methods: A scoping review, following the PRISMA-ScR guidelines, identified studies from the last decade using Pubmed/Medline, EMBASE, ERIC and Web of Science. Data was extracted into tables and reviewed using basic numerical analysis. The charted data was analysed using narrative synthesis and categorized using the Kirkpatrick model, with alignment to Miller’s Pyramid, to assess effectiveness of competency. Results: 31 studies highlighted a range of simulation and assessment strategies. 26% were categorized into the lowest form of competency, Kirkpatrick Levels 1(Miller’s “Knows”) and showed enhanced trainee confidence. 3% were graded as level 4 (Miller’s “Does”) and demonstrated competency through clinical outcomes. 35% were a mix of methods to assess learning on multiple levels simultaneously allowing in-depth multimodal assessment of learning. Conclusion: This paper suggests that an imbalance exists between the quantity of research versus the quality of research that formally assesses surgical skills acquisition at higher levels of competency. Thereby suggesting a demand for higher and reliable research to bridge the current gap in research and develop a more competency-based curriculum embedded with validated tools aligning with the higher levels of competency and supporting surgical autonomy and patient safety.