The Use of Deliberate Practice in Simulation-Based Surgical Training for Open General and Subspeciality Surgery: A Systematic Review

Simulation-based surgical training (SBST) provides a risk-free environment for surgical skill development. Integrating deliberate practice (DP) into SBST may enhance training effectiveness. This systematic review examines the application of DP elements in SBST for open general and subspecialty surgery, and their effectiveness in improving surgical skills. It aims to systematically synthesize the use of DP elements within SBST and evaluate effects on trainee performance. To preserve methodological comparability, this review focused on open procedures in general surgery and its subspecialties.The search identified 22 studies for inclusion, predominantly from North America and Europe. Most studies incorporated feedback and allowed repetition but commonly lacked structured assessments of learner motivation and individualized task design. Studies generally reported improvements in surgical skills after DP-informed SBST; however, the correlation between the number of DP elements used and learning outcomes was inconsistent. Kirkpatrick levels 1 and 2 evaluations were most common. The results suggest that DP-informed SBST improves skill acquisition in open surgery, although variations in DP implementation limit direct comparison across studies. Enhanced instructional design aligning closely with DP principles may bridge gaps in training quality, providing a structured pathway.