Exploring the deficiencies in technical skills postgraduate surgical training prior to the COVID- 19 pandemic: A systematic review and thematic analysis

Abstract Background: Postgraduate surgical training has evolved significantly, transitioning from traditional apprenticeship models to more structured competency-based programs. Despite these changes, concerns persist regarding the adequacy of technical skills (TS) training, exacerbated by modern challenges such as working time restrictions and the impact of the COVID-19 pandemic. This systematic review aimed to explore and understand TS training for doctors in postgraduate surgical training programs, focusing on issues prior to the COVID-19 pandemic. Methods. The search strategy was registered with PROSPERO a priori. Following PRISMA guidance, literature searches were conducted on electronic databases: Medline, Embase and grey literature using specific search criteria of studies published from 2016 to 2018. Studies that discussed TS postgraduate training in surgical specialities were eligible for inclusion. Data were extracted and analysed using inductive coding and thematic analysis. Results: Seventeen studies were included in the final analysis, predominantly from high-income countries. Thematic analysis revealed two main deficiencies in TS training: inadequate use of a multimodal approach and insufficient structure in training programs. Simulation training, while beneficial, was underutilised. Additionally, there were significant global discrepancies in training length and required competencies, with trainees often feeling less independent than expected upon programme completion. Conclusion: The review identifies critical areas for improving surgical training, emphasizing the need for a multimodal training approach and a more structured framework for delivery. These findings are particularly relevant for post-pandemic recovery efforts in surgical education, providing a foundation for targeted improvements in training programs.