Simulation unlocked: transforming thyroid surgery training through high-fidelity and curriculum-based innovation—a systematic review

Simulation-based and structured training have transformed surgical education, providing safe environments for skill acquisition and performance assessment. However, evidence in thyroid surgery remains fragmented across modalities such as simulation, video-based learning, intraoperative neuromonitoring (IONM), and fellowship programs. This systematic review aimed to synthesize primary evidence on educational interventions in thyroid surgery and their impact on technical performance and patient outcomes. A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted up to April 2025. Eligible studies included randomized trials, prospective or retrospective cohorts, and validation studies assessing simulation-based, structured, or supervised training. Two reviewers independently screened and extracted data, assessing quality using RoB 2, ROBINS-I, or CASP. Due to heterogeneity, results were summarized through a structured narrative synthesis by training modality. Ten primary studies (2011–2025) were included. Simulation and virtual-reality training improved technical performance, task completion time, and perceived realism. Supervised resident training reduced operative time after 30–50 cases, approximating senior benchmarks. Video-assisted learning decreased error rates by 49% and staff takeovers by 52%. IONM-based education lowered recurrent laryngeal nerve injury rates and enhanced procedural standardization. Fellowship-trained surgeons showed shorter operative times and fewer complications compared with non-fellowship peers. Across all modalities, training interventions improved either performance or safety outcomes. Structured educational programs—including simulation, supervised learning, and IONM or fellowship curricula—enhance surgical performance and safety in thyroid surgery. Despite limited quantitative evidence, findings support integrating multimodal, competency-based education into surgical training. Standardized outcome measures and multicenter validation are needed to define optimal learning pathways.