Lecture-based learning (LBL) is teacher-centered. The teacher imparts knowledge, which is passively received by students (Zhao et al., 2020). LBL relies on the availability of educational materials and the experience and skill of the lecturer (Chotiyarnwong et al., 2021). In one study, 106 students were randomly divided into an LBL-only group (control group) and one that integrated LBL with clinical problem-based learning (PBL); it demonstrated that the combination of the LBL and PBL approaches led to a deeper understanding and more effective use (p < 0.05) of burn-surgery knowledge, with students viewing it more favorably than in the case of LBL alone (Yao et al., 2020). Nevertheless, LBL relies heavily on teaching materials, skills, availability, and experience, with students receiving insufficient opportunities for analysis, practical application, and development of spatial and visual conversion abilities (Nawabi et al., 2021; Wang et al., 2022).

Case-based learning (CBL) emphasizes the discussion of patient cases (Muthukrishnan et al., 2019) based on the analysis of medical records. It is designed to represent real clinical settings and motivate students to recognize and expand new areas of learning. CBL facilitates self-learning through increased real-world relevance and understanding of concepts, problem-solving abilities, and the cultivation of students’ rigorous logical reasoning (Muthukrishnan et al., 2019; Zhao et al., 2020). Students apply fundamental biomedical knowledge to specific patient cases and overall clinical case management (Gartmeier et al., 2019). In a retrospective study, blending lectures and case workshops enhanced the learning climate (Sundbom et al., 2021). Moreover, students enjoy CBL courses, which teach a variety of problem-solving approaches while also stimulating a sense of active learning and competence (Nessler et al., 2021). In a 2023 study regarding online case-based surgical training series in Trauma & Orthopedics, over 90% of participants improved their skills and knowledge and expanded the scope of their surgical training (Brennan et al., 2023). However, in larger lecture environments, its utility may be limited (Pearson et al., 2018).

Effective learning environments should emphasize a culture where problem-solving skills, operative skills (Kronenfeld et al., 2022), critical thinking, and judgments are enhanced (White et al., 2004). PBL, a student-focused approach, prioritizes these. Trainees are assigned to groups of a maximum of eight students without the direct guidance of a tutor. This approach guides students to address issues via self-study, research, discussion, and collaboration within the group (Yao et al., 2020). In a prospective randomized trial including 175 medical students, PBL scored higher on the post-training multiple-choice examination than LBL for teaching theoretical surgery courses (p = 0.048) (Davari et al., 2021). PBL also promotes enjoyment and intrinsic motivation toward active learning, prompting students to adopt a deep learning approach (Dolmans et al., 2016). However, PBL is designed to be a hands-off approach—the teacher promotes group problem-solving and facilitates interaction through the use of non-directive questioning, but without lecturing or giving the answers (Dolmans et al., 2016; Yao et al., 2020).

Flipped learning (FL) inverts conventional classroom-centered learning. Students study the material before class, while face-to-face sessions focus on solving group problems and applying what they have learned (Tune et al., 2013). In a prospective non-randomized controlled trial, holistic FL teaching was viable in both medical and surgical education covering digestive disorders and otorhinolaryngology (Dombrowski et al., 2018). This approach improved student satisfaction, class attendance, academic outcomes (Hernandez-Guerra et al., 2021), and instructor time management compared to traditional learning (Barrett et al., 2022).

FL can assist students in gaining suture skills in various areas, particularly with their affective (β = 0.413, p < 0.001), psychomotor (β = 0.399, p < 0.001), and cognitive skills (β = 0.526, p < 0.001) (Wu et al., 2018). A randomized controlled trial focused on electrocardiogram (ECG) learning reported that flipped-classroom instruction resulted in the experimental group scoring higher in ECG interpretation compared with the control group (8.72 ± 1.01 vs. 8.03 ± 1.01, p < 0.001). The FL group invested more time learning before class than the control group did (42.33 ± 22.19 vs. 30.55 ± 10.15, t = 4.586, p < 0.001) (Rui et al., 2017).

This model has advantages and disadvantages. One advantage is that it integrates the benefits of face-to-face in-classroom instruction (e.g., teacher and peer engagement, applied problem-solving, collaborative learning) and internet-driven instruction (including self-regulated learning and digital video together with online discussions) (He et al., 2019). In terms of viability, time efficiency, and objectivity, FL may be superior to direct observations of surgical skills and clinical performance (Bock et al., 2020). Ultimately, students who received combined traditional teaching and digital media education (namely, FL) were better prepared to implement procedural skills than those who received only traditional teaching (Kraut et al., 2019). However, for FL to be successful, faculty must invest time in the preparation of materials prior to class, resulting in higher labor and material costs for their employers (Kraut et al., 2019).

Team-based learning (TBL) utilizes teamwork and in-depth critical reasoning; it requires pre-class study and integrates collaborative and active learning (Anas et al., 2022). TBL combines aspects of PBL and FL by having a single instructor conduct multiple group discussions. Teams work together to develop concepts and apply them to problem-solving activities in a single classroom (Lafleur et al., 2021; Yaqoob et al., 2021). Ideally, instructors create diverse groups of five to seven students (Shiels et al., 2017). The main TBL components include individual preparation (before class), readiness assurance (in class), application of concepts (small-group peer learning to complete tasks and student-assisted learning—in class), and long-term retention of knowledge (Sakamoto et al., 2020; Burgess et al., 2022). The learning content, objectives, and relevant resources are provided to each student 1 week before the lesson (Shiels et al., 2017). TBL helps students fulfill course-learning objectives and determine ways to be part of a team; students interact in the classroom and develop a sense of personal responsibility and teamwork behavior (Daou et al., 2022). The scores of the TBL group were considerably higher compared to the traditional self-directed learning group in a quasi-experimental study on undergraduate surgical education (74.70 ± 6.81 vs. 63.77 ± 4.18, p < 0.01) (Sim et al., 2023). However, TBL asks students to stick to the study before the class (Anas et al., 2022).

In simulation-based training (SBT), surgeons commonly divide the study material into various classification schemes: animal/non-animal, partial task/procedure, or virtual/real (Acton, 2015). Basic technical-skill task simulators and animated laboratories have been incorporated into the educational curricula of surgical students to teach fundamental surgical skills and procedures. Two examples of these include an abdominal cavity simulator (Ferreira Filho et al., 2018) and a simulator for corneal rust ring removal (Mednick et al., 2017). A prospective, randomized, blinded trial reported SBT as more effective (p < 0.001) and a more straightforward, intuitive, and easily understood approach (p < 0.001) than textbook learning, resulting in superior learning (p < 0.001) (Plana et al., 2019). Virtual simulations have been incorporated into operative procedure training, including otorhinolaryngology (Hardcastle and Wood, 2018), cesarean sections (Acosta et al., 2020), urology (Williams et al., 2021), and ophthalmology (Deuchler et al., 2022). Nevertheless, several challenges remain, such as the inaccessibility of virtual simulation teaching resources, the lack of infrastructure, the “decoupling” of users from reality, and the necessity to enhance student engagement and motivation (Wu et al., 2022). One study indicated that virtual reality might not be suitable for students with low visuospatial ability, while physical models might enable better learning, irrespective of visuospatial ability (Pang et al., 2021). In a retrospective survey study of a new type of informed consent module in virtual undergraduate surgical clerkship, a virtual module utilizing standardized patient and faculty communication skills training enhanced beliefs about students’ self-efficacy in gaining informed consent (p < 0.01) (Pang et al., 2021).

A single-center cohort study of 1,178 undergraduate students revealed that simulation-based medical education considerably increased students’ theoretical or practical achievement (p < 0.001), doctor-patient communication (improvement rate of 56.3%), and humanistic care (improvement rate of 69.2%) compared with the control group. In simulation-based medical education groups, the students were inclined to assign more time to interact with others (Wang et al., 2021).

Simulations utilizing standardized patients [defined as “a layperson trained to portray a patient, family member, and others in realistic and repeatable ways to provide practice” (Kim and De Gagne, 2018)] are widely used in UME, mainly for teaching physical diagnostic skills that involve anogenital and pelvic examinations (Low et al., 2015).

Robotic surgery is uncommon among final-year medical students; however, exposure to simulated robotic surgery allows a better understanding of related challenges, including depth perception and economy of motion (Naik and Mandal, 2020). The robotic simulator delivers a wider range of property measurements than other technologies, which allows students to improve their learning curve. It also enables doctors to communicate with patients promptly and effectively, further inspiring the next generation of robotic surgeons (Naik and Mandal, 2020).

Limitations of SBT, nonetheless, include financial barriers and fidelity (Nataraja et al., 2020). Surgical simulation research is frequently underpowered, due to considerable heterogeneity, while effective utilization of simulation requires the adequacy of all major factors, namely, trained educators, training resources, as well as the institutionalization of the curriculum (Miller et al., 2019; Mandal and Ojha, 2020; Iqbal et al., 2021).

The COVID-19 pandemic led universities worldwide to switch to distance learning despite constrained resources and preparation (Schlegl et al., 2020). Accordingly, online virtual teaching (e-learning) is now extensively accepted and expected by medical students. These technologies are essential for otolaryngology–head and neck surgery (Fung, 2015), surgical anatomy (Abi-Rafeh et al., 2021), urology (Margolin et al., 2021), neurosurgery (Hoffman et al., 2022), and plastic surgery (Koljonen et al., 2022) curricula, offering enhanced learning (Imai et al., 2022). In a study comparing in-person vs. virtual courses, no variations were observed in the efficacy of teachers preparing their students for oral examinations (6.4 vs. 6.8, p = 0.58) or National Board of Medical Examiners evaluations (6.2 vs. 6.7, p = 0.46) in the context of the COVID-19 crisis (Kronenfeld et al., 2021); this confirms that e-education sufficiently prepares students for exams (Kronenfeld et al., 2021).

Augmented reality (AR) offers a live representation of real-world environments while incorporating extra computer-generated elements (Luck et al., 2021). Online surgical education courses applying AR have been successfully delivered during the particularly challenging COVID-19 pandemic (Luck et al., 2021; Grady et al., 2022). This demonstrates that, when access to operating rooms is restricted, computer-based virtual education can be an effective and realistic alternative to traditional textbooks and face-to-face teaching (Kumins et al., 2021; Schmitz et al., 2021).

However, when the task is less demanding, the usefulness of AR applications is limited; for example, to fit particular task requirements, which include physical stress on the participant (weight > 500 g) and tissue disruption across the case (Tagaytayan et al., 2018; Gsaxner et al., 2021; Luck et al., 2021; Plewan et al., 2021; Tanzer et al., 2022). Besides, video-guided learning methods are inadequate for teaching surgical skills compared with those that use expert or peer feedback (Tejos et al., 2021). The SSuRF (Scene, Surgery, Reflection, and Feedback) method can assist in peer-led surgical training (Gracie et al., 2021). It enables peers, particularly those without adequate formal educational training, to use a structured format to teach junior students, which is then documented in workplace-based evaluations (Kennedy, 2022). Peer-assisted learning can improve average scores in many areas (Pinter et al., 2021), such as those included in the World Health Organization (WHO) Surgical Safety Checklist (+3.94), scrubbing (+2.99), gowning/gloving (+3.34), knot tying (+5.53), interrupted sutures (+5.89), continuous sutures (+6.53), vertical mattress sutures (+6.46), and local anesthesia (+3.73) (Bennett et al., 2018). Additionally, the effectiveness of a new system of interactive education with an emphasis on urological procedures can motivate student interest in surgery, demonstrating efficient surgical education within the operating room (Nakayama et al., 2016).

The Essential Skills in the Management of the Surgical Case (ESMSC) masterclass is another effective and innovative three-day multi-disciplinary teaching format for the international undergraduate surgical masterclass; it effectively improves students’ objective behavior in basic surgical skills (Sideris et al., 2018). During the global financial crisis of the National Health Service of the UK, the ESMSC model provided free, high-quality surgical education and subsequently developed into the Integrated Generation 4 (iG4) model via a dynamic feedback mechanism (Sideris et al., 2018). The iG4 curricula were built largely on the distinctive characteristics of the ESMSC, inviting a wide range of students from various educational backgrounds and enhancing interaction and the exchange of knowledge among them. iG4 concepts set the stage for a standardized, replicable, and novel effort to generate an undergraduate surgical skillset (Sideris et al., 2020).

In one study, participants with musical experience outperformed non-musicians on the Mini-Profile of Music Perception Skills test (p = 0.015), particularly in the speed of laparoscopic staple transfer (p < 0.01), suture quality (p < 0.03), and dexterity of the dominant hand (p = 0.05) (Sun et al., 2021). Dexterity together with the Mini-Profile of Music Perception Skills score had a predictive effect on suture quality (p < 0.01). In a case–control study of the COVID-19 pandemic, students undergoing an online surgical skills learning course performed comparably to those receiving traditional face-to-face tutoring in surgical skills, with average scores between 4 and 5 for both (Co et al., 2021).

The “Hand as Foot” teaching innovation refers to anatomical relationships, where clinical knowledge can be intuitively grasped and explained using the simplest gestures with hands and feet (Cui et al., 2020). It integrates the changes in the limb skeleton with clinical teaching in orthopedic education, which strengthens simulation and metaphor in teaching (He et al., 2021). This approach has been applied to ulnar olecranon fracture and patellar fracture surgery (Sun and Liu, 2021), spinal surgery (Chang et al., 2021), lumbar puncture (Xin et al., 2021), transcavernous sinuscranial nerve surgery (Zhang et al., 2021), thyroid surgery (Han et al., 2022), nursing, and rehabilitation interventions, among others (Guo et al., 2021). A point-by-point and integrated curriculum is formed by comparing the associated knowledge points of the upper and lower limbs. This new teaching model stimulates students’ interest while also enhancing their ability to think proactively; furthermore, it improves teaching, learning efficiency, student self-esteem, and sense of medical responsibility (Zhang Y. et al., 2022).

Game-based training is increasingly practiced in various areas of healthcare because it provides students with experiential learning and can be adapted to individual ability and progress (Akbari et al., 2022). In one study, average theoretical test scores were considerably higher in the game training group (n = 27) than those in the lecture training group (n = 24) post-training (p = 0.040) (Akbari et al., 2022).

A randomized controlled trial reported video-assisted peer feedback as a feasible and cost-effective alternative to the qualified instructor feedback typically employed in medical education (Boecker et al., 2022). In another approach, students’ performance regarding objectively assessed surgical skills was enhanced and their confidence was boosted following a two-week multi-modal surgical boot camp (Bevilacqua et al., 2020). Finally, animation can facilitate facial transplant education; it improved performance scores (p = 0.029), confidence, and satisfaction (p < 0.001) compared with learning via text resources (Wolfe et al., 2021).