Complexity in surgery lies at the crossroad between the complexity of the human body and the capabilities of the surgical tools available. While we continue to improve our understanding of the body, we are also inventing new tools to address and correct issues through surgery. As a result, the complexity of surgery is expanding on two fronts simultaneously. This creates a lifetime learning environment for practitioners and a challenge for the systems which educate, measure, certify, regulate, and privilege surgeons. The models of training in this field are slow to evolve and still rest on a foundation of lecture and hands-on practice which has changed little in 100 years. Surgeons largely believe that real hands-on practice with human tissue – excised organs, cadavers, and live patients – is the most effective form of training. But it is also the most expensive, difficult to facilitate, and least accessible form.
The emergence and maturation of the concept of blended learning in public and military education may prove equally valuable in surgical education and training. Creating a learner-centric environment in which multiple modes of education are encouraged, available, integrated, and accredited can potentially increase the level of competence of new surgeons, maintain competence in practicing surgeons, and provide objective metrics to the public and hospital systems.
This paper defines a framework for blended surgical training using principles developed for the military. This framework includes knowledge and skills-based training in both an individual and a group learning environment which includes distance and e-learning sessions, face-to-face engagements, laboratory events, and operating room experiences as modes of surgical education that are not integrated into a coherent program with defined metrics. The goal of the framework is to apply blended learning principles to the surgical education and training community, with reference to prior activities in public and military education.