# Augmented Reality–Enhanced Simulation in Surgical Education: A Scoping Review of Implementation, Skill Retention, and Equity in Low-Resource Settings

## TL;DR

This paper reviews how augmented reality (AR) can help train surgeons, especially in low-resource settings, but finds that more research is needed to confirm its long-term effectiveness and fairness.

## Contribution

The study provides a scoping review of AR's role in surgical education, focusing on implementation, skill retention, and equity in low-resource contexts.

## Key findings

- AR is mainly used for visual guidance and procedural training in simulated environments.
- Evidence for long-term skill retention and clinical transferability is limited.
- Low-resource AR systems show promise but are constrained by small samples and subjective measures.

## Abstract

Many developments have been made to enhance surgical training, including the usage of augmented reality (AR) simulation. However, its implementation within surgical training programs, impact on skill retention, and applicability in low-resource settings remain unclear. A scoping review was used to explore the role of AR technology and its implementation in surgical education, maintenance of skill retention, and equity and access in low-resource settings. A systematic search was conducted across four databases, which yielded 185 records, of which 30 met the inclusion criteria. Most studies were published after 2019 and evaluated AR interventions in simulated environments involving medical students or residents. AR intervention was primarily used for visual guidance, telestration and image overlay. Evidence for skill retention remains limited, with only four studies assessing retention outcomes. Short-term improvements in task performance and procedural planning were reported, while skills transfer to clinical environments and long-term retention remain underexplored. Several studies created low-resource, reusable AR systems, reporting increased learner confidence and procedural knowledge; however, these studies were limited by small sample sizes and a reliance on subjective outcome measures. In conclusion, current evidence suggests that AR has the potential to become a useful tool for surgical education. However, the literature remains preliminary, with more longitudinal, objective and equity-focused studies required.