The role of remote and virtual surgical training in expanding cardiothoracic surgical capacity in low-resource regions

Abstract

Cardiothoracic surgery remains one of the most challenging specialties to train in, particularly in resource-limited settings where traditional apprenticeship-based models remain impracticable. This article addresses how emerging digital technologies - virtual reality (VR) simulators, augmented reality (AR) platforms, artificial intelligence (AI) surgical training platforms, and tele-mentoring platforms - are transforming cardiothoracic surgical training globally. We present convincing evidence from African implementation studies demonstrating that these innovative approaches can effectively address critical training gaps. For instance, a recent systematic review identified that tele-mentoring initiatives in Rwanda significantly improved outcomes in cardiac surgery procedures. These technologies offer numerous advantages over conventional training methods, including risk-free simulation environments, standardized skill assessment, remote expert advice, and the ability to repeatedly practice complex procedures. However, significant barriers to large-scale implementation persist, particularly in low-resource settings. Significant barriers include limited technological infrastructure, high cost of implementation, lack of reliable internet connectivity, and resistance to changing traditional training paradigms. The article proposes a multifaceted strategy to cover these gaps and suggests policy adjustments to incorporate virtual training into national surgical education courses, low-budget simulation solutions establishment, global cooperation in training, and curricula tailored to environments. We make available successful worldwide collaboration models, such as the Pan-African Association of Surgeons’ VR learning program and Operation Smile’s virtual mentorship efforts. The discussion pinpoints the promise for strategic use of these digital training solutions in revolutionizing cardiothoracic surgery training in low-resource settings, ultimately enhancing access to lifesaving surgical services while maintaining high standards of training quality and patient safety.