**Figure 1.**

**Figure 2.**

*ADDIE instructional design model.*

**Figure 3.** *Mayer's cognitive theory of multimedia learning.*

mastery [15–18]. The observation of expert performance, with an introduction and performance of the task by the trainee, followed by mental practice with motor imagery augmented with deliberate practice, will need further authentication and validation.

More importantly, this model highlights the importance of applying instructional design models to create instructional materials and programmes for surgical skill acquisition. Instructional design (ID), the science of instruction, provides a systematic and evidence-based methodology for creating instructional materials for effective teaching. The various models and techniques have been used in surgical training [31–33].

A commonly used ID model for designing learning programmes is the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model in **Figure 2** [34] coupled with Mayer's cognitive theory of multimedia learning [35] in **Figure 3**. They can provide the framework for designing training programmes and materials for skill acquisition, which promotes mental simulation with deliberate practice in surgery training. Mayer's multimedia learning theory defines principles using texts, images, and audio to improve knowledge and skills acquisition. The theory explains how people learn through multiple sensory stimuli rather than a single channel such as texts, and empirical evidence showed that adding images and videos to words improves learning outcomes [36]. In addition, multimedia learning theories indicate best practices in designing multimedia teaching materials [37].
