Integrating tactile simulation into thoracic surgery education: a Miller's pyramid-Based study

Accurate intraoperative localization of pulmonary nodules remains a significant challenge in video-assisted thoracoscopic surgery (VATS), especially for small, deep, or subsolid lesions. This prospective cohort study evaluated the impact of a simulation-based training program using high-fidelity 3D-printed lung models on surgical trainees' spatial-tactile localization skills. A total of 67 postgraduate year 1-2 trainees were randomized into a lung model group (LMG) or a control group (CG). The curriculum comprised four sequential phases aligned with Miller's Pyramid: anatomical instruction, CT-to-anatomy mapping, thoracoscopic simulated localization, and intraoperative localization. Participants in the LMG achieved significantly higher scores in radiologic-anatomic mapping (6.94 ± 1.07 vs. 5.82 ± 1.07; p < 0.001) and simulated localization (2.09 ± 0.71 vs. 1.45 ± 0.87; p = 0.002). In clinical procedures, LMG trainees had a higher localization success rate (68.97%) compared to CG (66.67%), though not statistically significant (p = 0.877). Self-reported confidence and satisfaction ratings consistently favored the LMG. These findings suggest that anatomically realistic, simulation-based tactile training enhances thoracic surgery trainees' ability to mentally integrate radiologic data with intraoperative spatial reasoning. Incorporating such structured modules into thoracic surgical education may improve operative readiness and reduce reliance on adjunctive localization technologies.