# Development of a stakeholder-informed framework for the implementation of surgical sabermetrics to enhance training and education

## TL;DR

This paper presents a framework for integrating data-driven surgical performance metrics into training, using stakeholder input to guide implementation.

## Contribution

The novel contribution is a stakeholder-informed framework for implementing surgical sabermetrics to improve training and education.

## Key findings

- Stakeholders emphasized the importance of objective feedback and tracking trainee progression using data-driven metrics.
- Video-based delivery and real-time feedback were prioritized for technical skills, while dashboards were preferred for non-technical skills.
- Supervising surgeons and training leads were identified as key users of trainee data, with multimodal data integration deemed essential.

## Abstract

Surgical training relies heavily on subjective performance evaluation, which is resource-intensive and prone to assessor bias. Advances in digital surgery offer opportunities for objective assessment. While validity evidence for data-driven assessments increases, strategies for implementation in surgical training remain scarce. The aim of this study was to leverage stakeholder insights to develop an implementation framework for integrating data-driven surgical sabermetrics into training curricula.

Structured workshops were conducted at two international surgical conferences (the Association of Surgeons of Great Britain and Ireland Congress, Edinburgh, May 2025 and the International Conference on Surgical Education and Training, Edinburgh, June 2025). Delegates participated in facilitated discussions, interactive polling, and group concept-mapping exercises to explore opportunities, delivery modalities, access rights, and contextualization for surgical performance metrics. Stakeholder perceptions were used to iteratively develop an implementation framework, balancing applicability to current training pathways and capturing the nuances of data-driven insights.

A total of 54 surgical trainees and trainers from 13 countries contributed. Opportunities centred on enhancing objective feedback, assessing non-technical skills, and tracking trainee progression. Video-based delivery and real-time feedback were prioritized for technical skills, dashboards were prioritized for non-technical and cognitive skills, and structured reports were prioritized for performance-based metrics. Supervising surgeons and training leads were identified as essential users of trainee data, with integration of multimodal data (for example surgeon physiology, case complexity) deemed essential for contextualization.

This study presents an implementation framework for surgical sabermetrics in training. The framework provides practical guidance on delivery, access, and integration of performance metrics, supporting data-driven feedback to optimize trainee development, advance surgical education, and improve patient outcomes.

Data-driven surgical sabermetrics presents opportunities to advance training through enhanced insights, reliability, and objectivity. Identifying optimal delivery modalities, access rights, and data for contextualization is critical to realize the potential. Guided by stakeholder insights, this study proposes a framework for implementing surgical sabermetrics to enhance training and education.