Introduction​

Surgical education has transitioned significantly from its early twentieth-century apprenticeship-based approach to a modern, technology-driven competency-based model (1). Skills required include technical skills (dexterity and knowledge of instruments, risks, surgical anatomy, and steps in the procedure) and non-technical skills that encompass the formulation of the intervention plan, the ability to make decisions, leadership qualities in teamwork, and situation awareness — the capacity to gather information and anticipate future needs (2).
This evolution has been propelled firstly by technological innovations such as simulation and virtual reality, coupled with a shift from traditional, teacher- centred methods to more interactive strategies like problem-based learning, interdisciplinary teamwork, and flipped classrooms (3). Secondly by ethical concerns regarding patient safety, a litigious population, rising costs of care, duty hour restrictions, an array of surgical modalities to master (including laparoscopic, robotic, and endoscopic techniques), prolonged hospital stays, and procedure-related adverse outcomes (4).
These changes support a curriculum that builds surgical residents’ knowledge through scientific inquiry, research, and progressively increased responsibility (1). While  this  improvement  enhanced  training,  it inadvertently diminished the emphasis on patient care and ethics, leading to the subsequent integration of the medical humanities and communication skills, which are now gaining renewed focus (5). Continued public support and engaged leadership are critical to sustaining education, research, and care for underserved populations, reinforcing the system’s relevance and vitality in a continually changing landscape (6).
Modern learners now leverage various digital platforms, prompting educators to adopt diverse teaching methodologies. As surgical work hours become more restricted,    simulation—including    robotics, telemedicine, and gaming—has become integral to skill development (7). Basic surgical skills are primarily acquired in laboratory settings, allowing precious operating room time to be devoted to mastering advanced procedures (8).
This progression illustrates a clear trajectory from traditional methods to innovative educational strategies, ensuring efficient and effective training for future surgeons.

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Pedagogical Methods Shift
Surgical competency is achieved through an accumulation of scientific knowledge, psychomotor skills, and a professional attitude, each contributing to the specialist care of surgical patients with safety (9,4). Historically, this was accomplished through the apprenticeship model, with Halstead’s concept of surgical training based on three foundational principles: first, the trainee must have repetitive opportunities to care for surgical patients under the supervision of experienced surgical teachers; second, the trainee must comprehend the scientific basis of surgical diseases; and third, the trainee must receive graded responsibilities in patient care until achieving independence (10,11).
Most surgical curricula worldwide now focus on competency-based training, though arrived at from different starting points. The United States has transitioned from process-based learning to outcome- based learning, which encompasses more than just the clinical learning environment (12). The next Graduate Medical Education (GME) accreditation system (NAS) monitors competency from a milestone perspective. However, case logs have been shown to provide minimal evidence of competency due to the variability in complexity and the inconsistency of how residents log their cases. In the current issue the papers by Nthambi et al, Singh et al and Djoubairou et al demonstrate that large training centres may have large volumes of cases including rare conditions (13,14,15). The volume-based system can promote quantity over quality and lacks guidelines on how attending physicians should teach and assess trainee competence (16,17).
With duty hour restrictions, residents are expected to achieve competency levels comparable to that of their predecessors, despite shorter clinical training hours. This has led to the development of simulation-based training to expedite the learning process (18). A study utilizing ethnographic methods identified seven primary teaching strategies that range from knowledge transmission to fostering active student involvement: Questions and Answers, Lecturing, Piloting, Prompting, Supplementing, Demonstrating, and Intervening (3).

Technological Shifts
Incorporating video game-based skills training in surgical education has demonstrated effectiveness in enhancing technical abilities and patient safety. This approach particularly merits increased attention in the context of laparoscopic, robotic, and endoscopic surgical training (7). New technologies have induced significant changes both in surgical education and surgical practice. Technological advancements have not only improved learning by offering new resources for anatomy education (19) but have also facilitated real- time tele-mentoring (20), enhanced clinical examination processes (21), and enriched problem-based learning experiences (22) as well as procedural skills development (23).
Future advancements in surgical education may benefit from standardized evaluation metrics derived from data collection via wall-mounted cameras, microphones, and video feeds from laparoscopic instruments during general surgery cases, enhancing objective assessments of trainee performance (24).

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Use of Social Media
The integration of social media tools (including blogs, wikis, Twitter, Facebook, zoom and YouTube) into surgical education has yielded mixed results. A systematic review found that while some initiatives have struggled to demonstrate effectiveness in comparing student outcomes, those using blogging as a tool reported improved knowledge retention (25). Challenges in utilizing these platforms include time constraints and varying levels of engagement among learners, underscoring the need for a targeted approach to harnessing social media in educational settings.

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Conclusion
Surgical education is shifting from traditional apprenticeship to a dynamic, competency-based framework driven by technology and new teaching approaches. Simulation, digital learning, and social media are poised to shape the next generation of surgeons, while addressing duty hour restrictions, regional curriculum variability, and evolving societal healthcare needs to keep training relevant and effective for modern practice. This trend reflects a broader move toward versatile, evidence-based education that prepares surgeons to meet future clinical challenges.

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References

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