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Page 125 Mari et al. Art Int Surg 2022;2:122-31 https://dx.doi.org/10.20517/ais.2022.12

During training, significant discrimination was also reported with pregnancy experience and family
planning. Women were less likely to have children during surgical residency because of stigma, fear of
modification of their fellowship program, and perception of missing out on a job opportunity [20,52-55] . In
many countries, there is a lack of a formal policy for maternity leave or a maternity support program during
residency. This deficiency is another issue reported as an obstacle in pursuing a surgical career [55,56] .

All these barriers and discrimination experienced during surgical training led to a higher rate of burnout,
depression, and suicidal thoughts among female surgical residents compared to male trainees [50,57-59] . Thus,
female trainees were observed to be more likely to leave surgical residency [60-62] .

AIS IN SURGICAL EDUCATION AND TRAINING FOR WOMEN
[63]
AI is the study of how computers can understand, process, and act autonomously in the real world . In
AIS, machines perform interventional actions .
[16]

ML is a field of AI in which computers reproduce the acts of learning and solving problems, improving their
performance by learning from data [16,63] . AI models examine high volumes of data, and then offer accurate
predictions for upcoming events based on the statistical analysis of previous associations, and they
constantly improve with new data. Neural networks can develop over time thanks to incremental learning
processes, going beyond standard software [16,63] .

Natural language processing (NLP) is the interaction of AI and linguistics. NLP has advanced from essential
approaches (e.g., word to word) through an evolved process of coding words, sentences, and contexts .
[64]

Thanks to the aforementioned research, AI has already been employed in several fields in surgery, especially
to optimize patient management, support training, and improve surgical skills.

With AI, augmented reality offers enhanced vision by superimposing a digital image over the user’s view,
[65]
while virtual reality allows interacting with a digitally created setting . Surgical simulation based on virtual
reality (VR) allows training and practice in a safe setting so residents can learn from their errors without
[66]
harming patients . In the last few years, several surgical simulators for different surgical specialties,
procedures, and variants have been designed. The simpler ones are low-fidelity simulators that teach basic
surgical procedures. For example, the MIST-VR system was developed to teach basic laparoscopic skills,
suturing, and knot-tying . High-fidelity VR systems include the Lap Mentor which incorporates over 65
[67]
cases in the fields of general surgery, gynecology, urology, and bariatric surgery [68,69] . The potential of VR for
training and monitoring basic laparoscopic skills and full laparoscopic procedures is well recognized . The
[70]
routine use of surgical simulations can reduce operative times and complication rates, improving patient
outcomes .
[66]
VR simulations offer real-time feedback to users about their performance within the simulation. They can
evaluate time to complete a task, errors made during surgery, and the surgeon’s economy of movements ,
[71]
providing a method for skill evaluation that is objective and quantitative, not influenced by the gender of
the operator. Although VR simulations are burdened by some disadvantages, such as high costs, lack of
force feedback, and the limited realism of some simulation models , as VR technology advances,
[72]
simulators are getting more cost-effective and more able to reproduce human anatomy. A relatively new
development in training simulators is robot-assisted laparoscopic surgery simulators (RAS). Studies on Da
Vinci simulators suggest that they reduce the console training time, although RAS simulators are burdened
by high costs and a lack of high fidelity surgical simulations . However, the Da Vinci Skills simulator could
[73]