Paper Title

Abstract - Background: Novel Augmented Reality-based surgical simulator offers immersion and objective performance capture in surgical training, yet its thorough evaluation encompassing Kirkpatrick's pyramid levels is essential. Kirkpatrick's pyramid is a hierarchical framework used to evaluate the effectiveness of training, comprising four levels: Reaction, Learning, Behaviour, and Results. Methods: A holistic assessment of AR-based surgical simulators across Kirkpatrick's levels was performed using several studies looking at four main modalities. A pilot study(n=11) and a multi-centre study (n=6) were conducted to examine junior trainees'performance in appendectomies and vaginal cuff closures focusing on completion time and distance travelled metrics (Level 2). A concurrent study looking at self-confidence scores pre&post AR training using Likert scaling was performed (early indications of Level 1 and 3) A BMJ peer-reviewed health economics review in GBP was then performed via assessment of potential financial impact using AR-based surgical simulator on appendectomy costs (level 4) Finally, an independent systematic review (n=26) of the available appropriate literature on the main four modalities was performed. Results: Statistically significant reduction in both completion time and distance travelled with P-values (p<0.001,n=6) and (p<0.05,n=6) respectively, observed underscore the skill advancement facilitated by AR training (Level 2 outcomes). Moreover, the self-confidence scores improved, with a mean improvement of 3.82 (Likert, p=0.018) suggest not only higher trainee morale but also the translatability of acquired skills to real-world scenarios (Level 1&3 outcomes). In parallel, a health economics review a highlighted the potential economic advantages of AR-based surgical training, with estimated per-patient savings of up to £455, demonstrating concrete organisational benefits (Level 4 outcomes). Conclusion: The novel Augmented Reality-based surgical simulator showcased favourable outcomes across Levels 1 to 4. It not only boosted trainees' morale, confidence and skill translatability (Level 1&3 outcomes) but also presented substantial financial savings for organisations (Level 4 outcomes). AR-based surgical training showcased a significant reduction in completion time and distance travelled metrics which demonstrates improved skill acquisition (Level 2 outcomes). These findings collectively position AR as a transformative approach in surgical training, realising Kirkpatrick's objectives. It is important to note these findings focus on one speciality only and can be extrapolated to other specialities. Keywords - Augmented Reality, Surgical Training , Kirkpatrick's pyramid, Surgical Simulation, Organisational Benefits