Future of Surgery: Technology Enhanced Surgical Training: Report of the FOS:TEST Commission
Authors: Adebayo Oliver , Aldoori Joanna , Allum William , Aruparayil Noel , Badran Abdul , Winter Beatty Jasmine , Bhatia Sanchita , Bolton William , Giwa-Brown Lolade , Burke Josh , Carr Harry J , Chae Yeonwoo , Clements Joshua , El-Sayed Charlotte , Foster William , Gall Tamara , George Manish , Guest Francesca , Haq Makinah , Hardie John , Harris Matthew , Harvey Neil , Hoyle Antonia , Jalal Arif Hanafi Bin , Jesudian Gnararaj , Jiwa Natasha , Kalra Neeraj , Kapur Karan , Kawka Michal , Kazzazi Fawz , Keates Natasha , Kennion Oliver , King Martin , Lam Angela , Lemma Gedeon , Lim Jun Wei , Longman Patrick , Mikhail Mark , Mohammed Walid , Nasher Omar , Ngai Victoria , Okocha Michael , Pandit Anand , Pegna Victoria , Rehman Haroon , Toale Conor , Walker Eleanor , Wellington Jack , Wicks Catherine , Birchall Martin , Brennan Peter , Harji Deena , Irune Ekpemi , Janakan Gnananandan , Jayne David , McDermott Frank D , McMenamin Paul , Munsch Chris , Payne Steve , Peter Mark , Plastow Ricci , Smail Hassiba , Theodoreli-Riga Celia , Robson Andrew , Culmer Peter , Mallender Jacque , Price Richard 
Published: August 2022

Over the past 50 years the capability of technology to improve surgical care has been realised and while surgical trainees and trainers strive to deliver care and train; the technological ‘solutions’ market continues to expand. However, there remains no coordinated process to assess these technologies. The FOS:TEST Report aimed to (1) define the current, unmet needs in surgical training, (2) assess the current evidence-base of technologies that may be beneficial to training and map these onto both the patient and trainee pathway and (3) make recommendations on the development, assessment, and adoption of novel surgical technologies. The FOS:TEST Commission was formed by the Association of Surgeons in Training (ASiT), The Royal College of Surgeons of England (RCS England) Robotics and Digital Surgery Group and representatives from all trainee specialty associations. Two national datasets provided by Health Education England were used to identify unmet surgical training needs through qualitative analysis against pre-defined coding frameworks. These unmet needs were prioritised at two virtual consensus hackathons and mapped to the patient and trainee pathway and the capabilities in practice (CiPs) framework. The commission received more than 120 evidence submissions from surgeons in training, consultant surgeons and training leaders. Following peer review, 32 were selected that covered a range of innovations. Contributors also highlighted several important key considerations, including the changing pedagogy of surgical training, the ethics and challenges of big data and machine learning, sustainability, and health economics. This summates to 7 Key Recommendations and 51 concluding statements. The FOS:TEST Commission was borne out of what is a pivotal point in the digital transformation of surgical training. Academic expertise and collaboration will be required to evaluate efficacy of any novel training solution. However, this must be coupled with pragmatic assessments of feasibility and cost to ensure that any intervention is scalable for national implementation. Currently, there is no replacement for hands-on operating. However, for future UK and ROI surgeons to stay relevant in a global market, our training methods must adapt. The Future of Surgery: Technology Enhanced Surgical Training Report provides a blueprint for how this can be achieved.