Transforming Surgical Induction with AI Avatars: Confidence and Acceptability Among Junior Doctors in ENT Training (Preprint)

BACKGROUND Induction training for junior doctors in otolaryngology (ENT) must address a wide range of prior experience. Artificial intelligence (AI) avatars offer a novel approach to deliver educational content. This study evaluated whether an AI avatar-delivered ENT induction course could improve trainee confidence in key ENT clinical skills. OBJECTIVE To evaluate the feasibility, acceptability, and educational impact of an AI avatar-delivered induction course on junior doctors’ self-reported confidence in key ENT clinical skills. METHODS A modular online ENT induction course was developed using AI-generated avatar instructors (video-based, non-interactive) via the HeyGen platform. The course content covered otoscopic examination, endoscopic anatomy and pathology of the upper aerodigestive tract, management of ENT emergencies, triaging referrals, and acute airway management. Thirty junior doctors (Foundation Year 2, general practice trainees, core surgical trainees, and clinical fellows) at a tertiary hospital ENT department completed the course. Participants rated their confidence in seven ENT skills before and after the course on a 10-point Likert scale (1 = not confident, 10 = extremely confident). A post-course survey collected feedback on the AI tutors’ understandability, willingness to use AI-based learning in the future, and comparisons of the learning experience and content retention versus traditional methods. Paired t-tests were used to analyze changes in confidence. No objective skill assessment was performed. RESULTS All 30 participants completed both pre- and post-course assessments. Mean self-confidence scores improved significantly in all seven ENT skill domains after the course (mean increases ranging from +2.5 to +4.3 points on the 10-point scale; p<0.001 for each). The largest gains were in identifying normal endoscopic anatomy and in triaging ENT referrals. The AI avatar tutors were generally well understood (mean clarity rating 7.8/10). A majority of trainees (57%, 17/30) expressed willingness to take further AI-delivered courses, with 30% unsure and 13% unwilling. However, most participants (66.7%) reported no difference in their overall learning experience compared to traditional instructor-led videos, and 20% felt the AI format was inferior to traditional methods (only 13.3% reported an enhanced learning experience). Similarly, 70% perceived no impact of the AI tutors on their ability to retain material (13.3% reported enhanced retention, 16.7% reported worse retention). CONCLUSIONS An AI avatar-delivered induction course substantially increased junior doctors’ self-reported confidence across a range of essential ENT skills. The intervention was generally well received and accepted by trainees. Nevertheless, despite objective confidence gains, most participants did not perceive the AI avatars to improve their learning experience relative to conventional teaching, highlighting an important gap between confidence and perceived educational value. AI avatar tutors show promise as scalable tools in surgical education to supplement training, but further refinement—such as increasing interactivity—and evaluation (including objective performance measures) are warranted to optimize their effectiveness. CLINICALTRIAL n/a