Objective Evaluation of Three-Dimensional Models for Training Congenital Cardiac Surgeons: A Systematic Review

Objectives: This systematic review aimed to evaluate the types, validity, and outcomes of objective assessment tools used to measure surgeon performance during congenital cardiac surgical training using three-dimensional (3D) models. Methods: A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted from inception to December 2025 in accordance with PRISMA guidelines. Original studies reporting objective educational, technical, or performance-based assessments of surgeons undergoing surgical training using 3D congenital heart models were included. Results: Of 1359 records identified, 9 studies met the inclusion criteria. Objective assessments included procedure-specific checklists, global rating scales, time-based measures, and correlated clinical outcomes. Objective assessments consistently demonstrated improvements in technical performance and procedural accuracy, and reductions in task completion time, following simulation-based training. Evidence of skill retention was reported in a subset of studies employing repeated objective testing. Objective assessment of nonoperative technical skills and transferability to the operating room was reported infrequently and remained methodologically limited. Conclusion: Objective assessment using 3D heart models provides a measurable and reproducible means of developing technical skills and anatomical understanding in congenital and pediatric cardiac surgery. While simulation cannot fully replicate the complexity of the operative experience, these models may support early procedural planning, build strategies for anatomical exposure, and structured skills acquisition in a training environment increasingly limited by case complexity and operative opportunities.