In 2012, the Japan Surgical Society and the Japanese Association of Anatomists published “Guidelines for the Dissection of Cadavers in Clinical Medical Education and Research”. Subsequently, surgeons were allowed to use cadavers for surgical training : CST (cadaver surgical training). Previously, older surgeons used actual patients to teach younger surgeons their techniques, but CST allows young surgeons to safely learn surgical dissections and methods. If they make a mistake, they can redo it as many times as they want. They can also learn how to repair the damage. Off-the-job training (OffJT) before surgery includes conferences, preparation, and diagnostic imaging. OnJT and CST are both built on OffJT; CST makes health care services safer and improves health care economics.

Tohoku University has been conducting Cadaver Surgical Training (CST) since 2013 as a project subsidized by the Ministry of Health, Labour and Welfare, and a total of 328 people have participated in the program to date. One feature of the university's CST program is that participants can participate in multiple areas of training, such as otology, rhinology and head and neck, at a single workshop. We also provide practical training in voice and swallowing. In a survey of participants' understanding of surgical procedures conducted after CST, 78% of participants showed an increase in understanding after the CST, and 83% maintained this level of understanding after six months. CST enables mastery of the same techniques as those used in actual surgery and results in a better understanding of anatomy. These factors may have contributed to the training program's strong results. With growing social concern about medical safety, preclinical training is becoming increasingly important, and the need for CST is expected to increase further.

Analysis and visualization of the structures of techniques are necessary in order to transfer experts' surgical skills to young surgeons. Surgical techniques can be visualized by “quantification”, “verbalization” and “picturization”. We have “quantified” and “verbalized” the surgical techniques related to knot-tying and suturing, endonasal endoscopic surgery, and head and neck surgery including tumor resection. We have also used virtual reality technology as a tool for the “picturization” of surgical skills. These methods of visualizing surgical skills take surgical techniques, which have an artistic aspect, and provide them with a scientific view. In addition, in order to implement good surgical education, it is essential to improve the organizational environment. Here, we also introduce our strategic development of the proper environment for surgical education.

Cadaveric surgical training (CST) has several benefits, including the opportunity to learn common surgical dissections in real scale (3D), hands-on experience with surgical methods, and the capacity to learn non-surgical dissections that are not evident in actual clinical practice. Employing cadavers in surgical training is a highly helpful training strategy because it enables routine clinical practice monitoring of areas outside the operative field. Understanding of the impact of laryngeal framework compression and displacement on the vocal folds during laryngeal framework surgery allows for a better understanding of the fundamental ideas and mechanisms of the surgery. In transoral endoscopic and robotic surgery, CST provides an efficient way to learn the inside-out anatomy of the laryngopharynx and the surgical methods unique to these surgeries. Additionally, it is thought to be crucial for pre- and post-graduate education and recruitment.

Education of esophageal cancer surgery, which is a highly difficult surgery, has challenges such as the small number of cases, a lack of similar surgical procedures, and the possibility of serious complications. Cadaveric surgery training (CST), which is surgical training using donated cadavers, began to be performed nationwide in Japan with the publication of the “Guidelines for Cadaver Dissection in Education and Research of Clinical Medicine” in 2012. In a study of the learning effect of CST in a series of cadaveric surgery courses of video-assisted esophagectomy held by Hokkaido University, the total score of self-evaluations performed before and after the program (using a standardized evaluation form) doubled, with the effect especially remarkable for lymphadenectomy of the right recurrent laryngeal nerve and peri-aortic treatment. However the effect of CST was limited for lymphadenectomy of the left recurrent laryngeal nerve, which is the most difficult part of the operation. These results suggest that CST is effective for efficient learning of a series of surgical techniques, but that it is necessary to develop new educational programs such as a safe and efficient on-the-job training program using an intraoperative recurrent laryngeal nerve monitoring device, and on-demand teaching materials and simulators that can be learned through repetition.

For the success of surgical treatments, not only exceptional “techniques” but also abundant “knowledge” and appropriate “strategies” are crucial. In recent years, surgical education in thoracic surgery has undergone significant changes, with the transition from open surgery to minimally invasive surgery and the widespread adoption of robotic surgery. This paper discusses the paradigm shift in surgical education, the proposal of tailored simulation environments, and the surgical education methods practiced at Shinshu University. As the minimally invasive, tailored, and precise nature of surgery progresses, surgical education also requires responses such as the utilization of 3D imaging, the implementation of off-the-job training, and the tailoring and refinement of training. We propose a tailored simulation environment that meets the necessary elements for future surgical training, such as “sustainability”, “adaptability” to individual cases, and “reality” that can be reproduced in surgery. At Shinshu University, innovative surgical education methods, such as the use of pig explant cardiopulmonary models with vascular filling, surgical planning based on the 3D-S (Develop, Demonstrate, Discuss, & Share) concept, and scenario training, are being implemented. The development of further educational methods and the measurement of their effectiveness will be important challenges in the future.