Surgical skills training and simulation.

aining surgical competence is a complex, multifactorial process that ay take years of experience and on-the-job training. It is critical to rovide suitable educational opportunities to learn the necessary knowldge, judgment, and skills. A sound understanding of anatomy, physiolgy, pathology, and surgical principles is required. Similarly, surgical udgment, which may be particularly difficult to teach, is pivotal in dministering appropriate patient care. Although knowing what to do knowledge) and when to do it (judgment) are critical aspects of surgery, aving the requisite skills is also imperative. The traditional emphasis in training has been to immerse trainees in linical environments for a prolonged period of time. At the turn of the 0th century, surgical training addressed all facets of competency in an rganized fashion. Dr. William Halsted, Chief of Surgery at Johns opkins Hospital in 1892, was the first surgical educator in the United tates to establish an organized and prolonged training system (8 years on verage). This model placed a heavy emphasis on learning the science of urgery and related disciplines while simultaneously immersing trainees n a supervised clinical setting with increasing levels of responsibility. In ssence, Halsted’s introduction of this structured apprenticeship model ormed the basis of the modern American residency system. This model has undergone scrutiny and modification. With the introuction of new technologies, more complex procedures, and a host of xternal constraints, the doctrine of learning primarily through supervised atient care experiences has been superseded by efforts to teach in onclinical environments. One of the primary targets has been the cquisition of technical skills—a focus that has been somewhat neglected n the past. Teaching technical skills outside of the operating room makes ntuitive sense but was not pursued until pioneering efforts took place ver the past 3 decades. One of the earliest examples was in the field of rthopedic surgery, when Lippert and colleagues described a course on otor skills for residents at the University of Washington in 1975. In the