Impact of augmented reality on the acquisition of minimally invasive surgical skills: results of a counterbalanced study on master's and bachelor's students

<h2>Abstract</h2><h3>Background</h3> Minimally invasive foot surgery (MIS FS) has gained popularity due to several advantages but teaching these techniques is challenging. Traditional methods like observation, cadaver practice and simulators have limitations. Augmented reality (AR) merges virtual content with the real environment, generating 3D reconstructions that could optimize surgical training. This study compares AR versus traditional methods for teaching hallux abductus valgus (HAV) and fifth metatarsal osteotomy. <h3>Methods</h3> Crossover design was conducted with 80 podiatry students over 4 years. HAV surgery was taught using AR materials while bunionette surgery used PowerPoint and video in a counterbalanced order. The results of the educational intervention were evaluated with the validated Survey for Assessment of Educational Media in Anatomy and Surgery (SAEMAS). The AR interface allowed interacting with 3D bone models reconstructed from medical images. <h3>Results</h3> AR showed benefits on motivation (d = 1.08), concept retention (d = 0.97), visual comprehension (d = 2.15), self-study (d = 1.4) and active learning (d = 1.58) (all p < 0.001). No difference was observed for avoiding frustration or replacing cadavers. <h3>Conclusions</h3> Integrating AR as a complementary teaching material in minimally invasive foot surgery improves motivation, understanding and psychomotor skills. AR does not replace traditional methods but enhances learning. The ability to manipulate interactive 3D models facilitates deeper learning of complex anatomy and techniques before operating on patients.