Training tomorrow’s surgeon: skills beyond the scalpel

Surgery is on the cusp of technological transformation, redefining how we operate, make decisions and care for patients. While tech often takes centre stage, less discussed are the skills surgeons need to drive this change. 

As medical students, we occupy a unique position: close enough to appreciate current surgical practice, yet distant enough to represent the generation inheriting these changes as consultants around 2040. From straining for a view in theatre to trailing behind ward rounds, we experience surgery with a fresh perspective. This perspective, often overlooked, deserves a voice as the future of the field. Amid the tick-box pressure of exams, electives and publications, we pause to reflect on the surgeons we are becoming, asking: what will define surgical excellence in 2040?

Drawing on our medical school experience, we explore four emerging competencies shaping future surgical practice, with wide implications for future and current surgeons. 

Data as the surgeon’s instrument

Tomorrow’s surgical precision depends not only on robot-steadied hands but on sharp data insight. Across the perioperative pathway, increasing depth and breadth of patient data will elevate data literacy as a core competency. 

Preoperatively, tools like multi-omics will personalise management, from infection risk to tumour-tailored treatment¹. Machine-learning models like MySurgeryRisk already outperform clinicians at predicting postoperative complications^2,3. Intraoperatively, AI computer-vision can record surgical performance⁴ and detect tumour margins in real time⁵. Postoperatively, wearables alongside advanced algorithms will act as early warning systems, flagging complications days before symptoms emerge⁶. These seemingly futuristic technologies, though still experimental, are actively being developed and trialled. 

As predictive models drive perioperative decision-making, surgeons must engage with data literacy, beyond occasional meta-analyses, to develop critical reasoning to challenge model output, assumptions and limitations – all crucial in avoiding its misuse.

While surgeons are not professional data scientists, they need sufficient literacy to collaborate with informaticians. The argument ‘that’s what statisticians are for’ may apply to complex trial design but, as predictive models increasingly influence decision-making, the responsibility ultimately rests with the clinician, on whose authority these data-driven decisions are made. As medical students, we experience this shift through mandatory modules like UCL’s Doctor as a Data Scientist⁷, introducing critical appraisal of healthcare AI alongside concepts such as model calibration, bias, validation and performance drift, the emerging lingua franca of surgical data literacy.

Ethical implications also emerge. As predictive models inform surgical decisions, surgeons must adequately communicate their influence to patients or risk undermining informed consent. This becomes increasingly important as health-literate patients now use AI-driven insights into prognosis and treatment options. We therefore foresee future OSCE stations assessing our ability to clearly communicate AI-derived insight to patients or balancing surgical judgment with model outputs.

Surgical data literacy should enable future surgeons to balance clinical judgment with algorithmic advice, manage information overload and develop a shared language with informatics teams. In a world of ‘black box’ AI, surgeons should also advocate for clinician interpretability and surgical involvement in tool development.

The adaptive surgeon

The accelerating rate of innovations⁸ demands adaptability. Advances in genomics, AI, robotics and imaging are reshaping surgical pathways, rendering some procedures obsolete, transforming others and creating entirely new approaches. Surgical globalisation amplifies this⁹, as easier information exchange enables best practice to cross borders, emphasising adaptability – the skill of acquiring new skills. Recognising this, The Royal College of Surgeons of England’s Future of Surgery Report¹⁰ recommends undergraduate exposure to emerging technology and disciplines, providing a longer runway of familiarity.

A defining feature of this is hybrid expertise. As minimally and non-invasive approaches consume more cases, future surgeons will be pushed towards a broader skill mix. During a surgical elective in Singapore, we observed vascular neurosurgeons dual training to both invasively clip and non-invasively coil cerebral aneurysms. Such crossover will challenge traditional training.

Technology will support this adaptability. As surgeons increasingly transition between open, endoscopic and robotic techniques, training platforms will streamline skill acquisition and maintenance, reducing the risk of skill atrophy in open and emergency procedures, helping surgeons to avoid becoming ‘jacks of all trades, masters of none’. As medical students, we already experience these benefits through AI-powered ‘digital tutors’, which personalise question banks, simulate patients and even anticipate obscure questions from consultants.

Today, robotic surgeons must first achieve objective performance metrics in simulated environments, including dexterity and efficiency. At Oxford, we experience this at first hand through VR workshops simulating theatre workflows. It is a welcome evolution from the ‘see one, do one, teach one’ model towards more efficient and personalised feedback loops. This also encourages greater ownership of self-directed learning, potentially offsetting the de-emphasis of surgery in medical curricula.

The surgical conductor: communication and teamwork

A surgical mentor once remarked: “You’d think technical competence is the biggest challenge as a surgeon, but it’s actually communication and people management under pressure.” Indeed, poor communication remains a leading cause of surgical ‘never events’¹¹.

Although ‘multidisciplinary’ has become a buzzword, future surgical teams will fully embrace this concept as perioperative care is optimised by input from technicians, radiologists, nutritionists and, looking forward, evolving expertise including AI experts, bioengineers and geneticists. And the theatre team is evolving, as physician associates and nurse practitioners become more commonplace. 

In this ecosystem, surgeons may act as conductors: coordinating diverse expertise in and out of theatre. However, this leadership role is not guaranteed by seniority or skill, requiring a mindset shift, communication and teamwork training. Surgeons must be ready to lead and be led. 

Effective communication will increasingly extend internationally through digital platforms. Recent conflicts in Ukraine¹² and Palestine¹³ highlight the value of global surgical networks and remote expertise. Even as students, we co-author research and arrange joint virtual events with peers across continents, ultimately laying the groundwork for a generation of surgeons who are globally minded, technologically adept and effective communicators.

Beyond the operating theatre: portfolio careers

Traditionally, one was either a surgeon or was not. The future, however, is shifting toward portfolio careers, blending clinical practice with education, innovation, research and leadership. Many of our mentors already consult for industry, lead academic programmes or influence policy. Hybrid identities, such as surgeon-entrepreneur¹⁴ or surgeon policy-advocate¹⁵ – are on the rise. At their core, these individuals remain skilled surgeons. However, their broader contributions will redefine surgical impact, such as global health and technological advancement. For some, theatre will remain their focus. For others, this diversification brings renewed meaning. Many of our peers pursue projects in technology, global surgery and entrepreneurship, enriching their future surgical development.

A cultural shift is also under way. The notion of surgery defined by self-sacrifice is being dismantled. In 2024, a third of British doctors reported signs of burnout¹⁶, potentially increasing the risk of surgical error 2.5-fold¹⁷.

Surgery will always be demanding, but toxic training environments should give way to compassionate leadership. Recognising limits, managing stress and prioritising reflection are hallmarks of sustainable training. Future surgeons will continue operating with excellence, but will also advocate for healthier cultures and take guilt-free rest days, returning with renewed clarity and compassion. As we are reminded in medical school: ‘You cannot pour from an empty cup.’ 

Conclusions

While technologies advance rapidly, it is the surgical workforce’s skillset that determines if these innovations translate into patient benefit. The question is no longer if disruptive innovations will arrive, but whether current and future surgeons are trained to use them effectively. Data literacy, adaptability, communication and collaborative leadership will no longer be optional and, although they are increasingly emphasised in curricula, they should also be championed by current leaders. After all, who trains the trainers? 

We may not know exactly what future surgery will look like, but the qualities defining our generation of surgeons are already taking shape. This future is closer than we think.

We welcome any discussions or potential collaboration inquiries. Contact the lead author at omar.ouaretsorr@gtc.ox.ac.uk

Acknowledgments Jennifer Graystone, Shu Kiat Chan, Amlaan Parida

References

1. Verdonk F, Einhaus J, Tsai AS, Hedou J, Choisy B, Gaudilliere D, et al. Measuring the human immune response to surgery: multiomics for the prediction of postoperative outcomes. Curr Opin Crit Care. 2021;27(6):717-25.

2. Bihorac A, Ozrazgat-Baslanti T, Ebadi A, Motaei A, Madkour M, Pardalos PM, et al. MySurgeryRisk: Development and Validation of a Machine-learning Risk Algorithm for Major Complications and Death After Surgery. Ann Surg. 2019;269(4):652-62.

3. Brennan M, Puri S, Ozrazgat-Baslanti T, Feng Z, Ruppert M, Hashemighouchani H, et al. Comparing clinical judgment with the MySurgeryRisk algorithm for preoperative risk assessment: A pilot usability study. Surgery. 2019;165(5):1035-45.

4. Cao J, Yip H-C, Chen Y, Scheppach M, Luo X, Yang H, et al. Intelligent surgical workflow recognition for endoscopic submucosal dissection with real-time animal study. Nature Communications. 2023;14(1):6676.

5. Chen H, Gou L, Fang Z, Dou Q, Chen H, Chen C, et al. Artificial intelligence assisted real-time recognition of intra-abdominal metastasis during laparoscopic gastric cancer surgery. npj Digital Medicine. 2025;8(1):9.

6. Hughes CML, Jeffers A, Sethuraman A, Klum M, Tan M, Tan V. The detection and prediction of surgical site infections using multi-modal sensors and machine learning: Results in an animal model. Front Med Technol. 2023;5:1111859.

7. University College L. UCL launches Doctor as Data Scientist module. UCL Health Informatics. 2019.

8. Lingam G, Shakir T, Francis N. New technologies in surgery: development, evaluation and training. The Bulletin of the Royal College of Surgeons of England. 2024;106(8):486-90.

9. Bolton WS, Aruparayil N, Quyn A, Scott J, Wood A, Bundu I, et al. Disseminating technology in global surgery. Br J Surg. 2019;106(2):e34-e43.

10. Royal College of Surgeons of E. Future of Surgery Report. London: Royal College of Surgeons of England; 2018.

11. O'Daniel M, Rosenstein AH. Professional Communication and Team Collaboration. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. p. Chapter 33.

12. Best J. From Ukraine to remote robotics: how videoconferencing and next generation technology are transforming surgery. BMJ. 2022;377:o1078.

13. Alser K, Mallah SI, El-Oun YRA, Ghayada M, Sammour AA-K, Gilbert M, et al. Trauma care supported through a global telemedicine initiative during the 2023–24 military assault on the Gaza Strip, occupied Palestinian territory: a case series. The Lancet. 2024;404(10455):874-86.

14. Bachelani AM, Soliman MK. Surgical entrepreneurship: Navigating the intersection of medicine, business and leadership. Seminars in Colon and Rectal Surgery. 2025;36(2):101101.

15. Liebe HL, Buonpane C, Lewis S, Golubkova A, Leiva T, Phillips R, et al. This is Our Lane: A Pilot Study Examining the Surgeon's Role in Social Justice Advocacy. Am J Surg. 2022;223(1):194-200.

16. General Medical C. The state of medical education and practice in the UK: Workplace experiences 2024. London: General Medical Council; 2024.

17. Garcia CL, Abreu LC, Ramos JLS, Castro CFD, Smiderle FRN, Santos JAD, et al. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina (Kaunas). 2019;55(9).