Artificial intelligence (AI) based devices are currently being used in the delivery of
surgical care in a variety of settings.[1,2] However, AI-enabled systems can trigger a variety of opinions and
emotions, which reveals the different lenses that shape views on AI. Nonethless, work within
surgical education may necessitate a more balanced view; with an acknowledgment of the
participation of AI-enhanced devices in the delivery of surgical care and education, and
consideration for how individuals can best utilize and complement these tools.In order to support a nuanced discussion of AI in surgical care, we can explore how AI has
been reported and discussed in the literature. Unfortunately, the literature defining and
describing AI is fragmented; likely contributing to the diverse views and reactions to
AI-enabled technology. Hence, this editorial will synthesize a variety of definitions from
various AI-adjacent fields in order to provide a brief and accessible definition of AI for
surgical education, promoting and supporting dialogue amongst disciplines based on a shared
understanding.Based on examining definitions in computer science/engineering, AI is
commonly defined as intelligent agents (ie system/program that can learn, adapt, change, and
respond based on the inputs received from their environment) that act to achieve the best
possible outcome, focusing on optimization of uncertain answers.
As 1 example, AI-enabled alogrithm results in Google “predicting” what webpage would be
most relevant to your search. In Kindergarden-12 and general higher
education, AI is commonly defined as a computer-based learning system that performs
tasks traditionally fulfilled by educators or tutors at an equivalent or superior level,
adapting to the needs and goals of learners while providing personalized feedback.
Examples include personal and collaborative tutoring systems that provide immediate,
user-adaptive feedback to students. In health care, AI is
commonly defined as a branch of engineering and computer science which creates systems
programmed to function and replicate intelligent human behavior, analyze complex medical data,
assist physicians in diagnosing diseases, assist surgeons during a procedure, develop drugs
along with treatment plans, predict patient outcomes, and determine optimal resource allocation.By drawing on the above definitions, we suggest the following definition for AI in surgical
education: An intelligent system/program that acts to fulfill or support the
fulfillment of educational tasks traditionally performed exclusively by Surgical Educators,
through making decisions in a manner similar to educators and providing customized
adaptation, including performance assessment and feedback, to surgical
trainees.With this definition in mind, we also suggest that AI systems used in surgical education can
be classified in a variety of ways. The most straightforward means is to consider the core of
how the AI system is programmed to work: with or without explicit rules. Rule-based
AI generates pre-defined outputs based on certain rules programmed by humans,
exhibiting ‘fixed intelligence’ by following a series of rules and instructions in a tree of
steps (eg, decision tree). For example, an intelligent tutoring system developed to teach and
assess cognitive and procedural skills required in basic robotic suturing, that uses
interactive conversation trees and changes the content that students progress through (based
on a baseline knowledge test and knowledge checks along the way) is an example of a rule-based
AI system.
On the other hand, non-rule-based AI simulates human intelligence to
perform tasks without necessarily relying on pre-determined rules, building algorithms that
automatically adapt to change, and this is the most popular application of AI in surgery and
surgical education.[8,9] For example, using supervised
machine learning algorithms (artificial neural networks) to classify patterns of performance
that distinguish between expertise levels in a virtual reality Sim-Ortho simulation task is an
example of a non-rule-based AI.In conclusion, our definition contributes to building a shared understanding of AI in
surgical education, which is an important step in building and strengthening bridges between
and across disciplines, to enhance the development and application of AI into surgical
training and associated research. Currently, progress is being made to develop AI-enhanced
surgical education tools, such as virtual simulations that allow for personalized, flexible,
and dynamic learning environments that would not be otherwise possible. As with any
educational tool or technology, AI can be a powerful component of our eduational arsenal, when
used purposefully and embedded thoughtfully within educational programs.