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Key Points

  • image Learning basic skills at the point of care imposes inefficiencies that might very well endanger support for the education mission.

  • image In 2006, the Accreditation Council for Graduate Medical Education Residency Review Committee for Surgery instituted a formal requirement for simulation training in surgical residency.

  • image Procedural skills training in a simulated environment has been shown to transfer to the real-life clinical setting.

  • image Early studies of virtual reality training using both proficiency-based and non–proficiency-based training methods showed it to be an effective means of improving laparoscopic skill both in the lab and in the operating room compared to non–virtual reality trained controls.

  • image Use of proficiency-based training in the context of a larger curriculum appears to be the best way to achieve good training results irrespective of the training platform used.

  • image When assessing simulator validity, researchers have noted that the use of robotic surgery simulators does translate to the clinical environment and the learning curve for initial console training for surgeons is significantly decreased.

  • image Simulation training for communication and other teamwork-pertinent nontechnical skills requires learners to be embedded in realistic scenarios pertinent to a healthcare team’s actual clinical responsibilities.

  • image Simulation technology allows trainees the opportunity to execute a variety of tasks and procedures while also experiencing the cognitive demands of surgery, including error correction and surgical planning decisions.

  • image The immediate future of simulation in surgery will likely see expanded use of proficiency-based training given the consistent demonstrations of effectiveness in improving surgeon skills and improved educational outcomes as measured in clinical settings.

  • image Advances in wearables, motion tracking, and sensor technologies allow for a wide variety of hybrid and augmented experiences in simulation as well as extensive opportunities for the development of new performance metrics.



The basic American surgical training model is patterned after that established by William Steward Halsted at the Johns Hopkins Hospital in the late 19th century. By tradition, it has consisted of a regulated apprenticeship system with incremental increases in clinical responsibility for resident surgeons over a specified period of time culminating with the expectation that independent surgical practice will be possible at its conclusion. While this approach has served well throughout the 20th century, the pace of changes in healthcare delivery and society itself has driven the need for new approaches to education and training. Among the important changes that the surgical training community has had to confront are an expanding array of medical and surgical therapies, complex, new and sometimes disruptive technologies advancing at a dizzying pace, and increasing recognition of the opportunities for errors and adverse outcomes because of inadequate preparation for this new world of surgical practice.1 Appreciation of the scale and insidious consequences of medical errors began to take hold in the 1990s when the groundbreaking Institute of Medicine report “To Err is Human” presented to the public a dire picture of the frequency and implications of ...

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