Virtual reality and biofeedback in surgical training: a review and proposal for comparative study between novice and experienced surgeons

Virtual reality (VR) is increasingly adopted in surgical education as a safe and controlled environment for developing technical and non-technical skills. Parallel to this, physiological biofeedback has emerged as a promising method for assessing stress, workload, and cognitive performance during complex tasks. This review explores the current evidence on VR and biofeedback in surgical training, highlighting their synergistic potential. We discuss how VR simulations replicate operative scenarios with high fidelity and how biofeedback parameters such as heart rate variability and galvanic skin response can provide objective insights into surgeon performance and stress regulation. We then outline a pilot study design in which novice and experienced surgeons are placed in a VR operating room scenario, with biofeedback metrics recorded. We hypothesise that experienced surgeons will demonstrate more stable physiological responses and superior task performance, reflecting greater resilience and expertise. Such findings could inform adaptive, personalised training models that adjust difficulty levels or provide targeted feedback in real time. Integrating VR and biofeedback into surgical education has the potential to enhance skill acquisition, improve stress management, and bridge the gap between simulation and the operating room.