Artificial intelligence augmented tutoring vs expert instruction on learning simulated general surgical skills: a systematic review and meta-analysis
Abstract
Background: Surgical training suffers from a global deficit; 5 billion people lack access to safe surgery, with an estimated 143 million additional procedures needed annually. Traditional surgical education, constrained by the apprenticeship model, faces critical limitations in standardization and scalability, particularly in low- and middle-income countries where expert mentors are scarce. AI-augmented tutoring systems represent a potentially transformative solution. This systematic review and meta-analysis were conducted to address that evidence gap.
Methods: Following PRISMA 2020 guidelines, we systematically searched major databases for trials comparing AI tutoring with expert instruction. Primary outcomes were performance (Intelligent Continuous Expertise Monitoring System [ICEMS] score) and skill acquisition (Objective Structured Assessment of Technical Skills [OSATS] score). Cognitive load was a secondary outcome, measured using the Mental Effort Scale (MES) and Cognitive Load Index (CLI).
Results: Our search yielded 40 studies for narrative synthesis. Four studies (3 RCTs and 1 pilot prospective study), encompassing a total of 268 participants, were included in the meta-analysis. AI tutoring showed a small, statistically significant improvement in expert-rated OSATS scores (MD 0.20; 95% CI, 0.01 to 0.39) with no heterogeneity (I2 = 0%) but with low certainty. The AI group reported a significantly higher extraneous cognitive load (MD 0.23; p = 0.01). No significant…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 268 participants or records.
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