Our search strategy yielded 104 studies. After screening, 11 studies were included in this review. The studies were of heterogenous quality (MERSQI range 9.6–15). Among the 11 studies, there were a total of 636 medical students. All were in their clinical years (third year or above or explicitly stated). Participants attended a surgical curriculum comprising of online courses or combined online and face-to-face teaching. The surgical skills taught included suturing, knot tying, and instrument identification.

Methods of Surgical Education

Interventional methods for online education included the following:

Live web-based video [11, 14,15,16,17, 20].

Self-directed video [12, 13, 18, 21].

Both web-based video and standard conventional teaching [19].

The primary outcomes for all studies included were post-intervention proficiency, satisfaction or confidence in surgically related skills, and knowledge. Five studies used the objective structured assessment of technical skills (OSATS) to measure proficiency [11, 13, 18, 20, 21]. The results of each study are summarised as a table (Appendix Table 1).

Confidence and Satisfaction of Participants Using Online Learning

Six studies assessed the satisfaction or confidence of online learning by medical students.

Through online teaching, Quaranto et al. [17] found a significant increase in the confidence of medical students in both knot tying (p = 0.03) and suturing (p < 0.001) pre and post programme.

Similarly, Shin et al. [15] found that following a virtual case-based curriculum, students had significantly improved self-confidence to independently complete a surgical clerkship by the end of the programme (5-point Likert scale: pre-programme 2.0 and post-programme 4.0, p = 0.0001). Here, students were presented with a surgically related case and students would take a medical history, request physical examinations, and discuss differential diagnoses.

Newcomb et al. found. [14] students reported increased confidence in gaining trust and building rapport of surgical patients through online video communication. The virtual class utilised role playing and feedback from simulated patients. Here, students explored understanding, concerns, and perception of patients as well as forming action treatment plans. Eighty percent of students rated this curriculum ‘A + ’.

McGann et al. [13] implemented online programmes where suturing, surgical instrument identification, and knot tying were used to teach surgical skills. They found a significant increase in confidence of students regarding suturing, surgical instrument identification, and knot tying (p < 0.0001, p < 0.0001, p < 0.0001, respectively). Students also felt positively regarding learning and interacting with the instructor through online platforms.

Bochenska et al. [19] recorded high student satisfaction in both video and non-video groups and de Sena et al.  [20] reported all participants found video-based learning was more favourable compared to text-based learning.

Proficiency of Surgical Skills and Knowledge Through Online Learning

For skill competency, four comparative studies found no significant difference between the control and video-based learning group (face-to-face) for the education of procedural surgical skills [11, 18, 19, 21]. Two of these studies measured skill capability at longer periods of time and reported no difference between the video-based learning groups and control. [11, 19] Two other studies highlighted the improvement in surgical knowledge with the addition of video-based learning as an adjunct [12, 25].

Co et al. [11] utilised web-based learning of surgical skills. Here, demonstrations by tutors and practice by students of surgical skills were conducted on online platforms. They reported no significant difference between the face-to-face and web-based learning groups following OSATS (4.8/5 and 4.7/5, respectively, p = 1.0).

Shin et al. [15] found a significant improvement in assessment score for knowledge regarding surgically related content through a virtual case-based curriculum from pre and post programme (p value 0.0002). Similarly, Pettitt-Schieber et al. [21] recorded a significant increase in knowledge of the surgical subspecialty programme after education through online platforms (p < 0.0001).

Handaya et al. [12] reported that students that received a video for knot tying scored significantly higher compared to those that did not watch the video (p < 0.0001). Following assessment by OSATS, de Sena et al. [20] recorded a better performance in those receiving online education compared to text-based education (post-test results (p < 0.001).