Simulation-based training of surgical skills

First of all, it is important to acknowledge that simulation-based training cannot replace traditional apprenticeship training. New surgical trainees must be supervised by more experienced colleagues during their first real procedures just as simulator trained pilots start out as co-pilots. Furthermore, we need to rethink the extreme focus on simulation equipment that has been the hallmark of the literature concerning advanced technical skills training. Nesbitt et al. carefully list the different pros and cons of synthetic models, animal models, virtual reality simulators, and human cadavers and even describe an ideal endovascular training model. Rightfully, they end up concluding that: ‘The biggest current barrier to the routine integration of simulation into endovascular training is the lack of an agreed curriculum’— not the lack of equipment. There is no doubt that the ‘boys and their toys’ phenomenon has resulted in many expensive simulators being covered in dust once the initial enthusiasm has disappeared. A viable training programme based on the best available evidence should be planned before investing time and money in simulation-based training. Creating professional simulation centres that are used by many departments and hospitals is an efficient way of countering potential problems with costs, licenses, logistics etc [5]. However, we totally agree with Nesbitt et al. that: ‘Simulation should not be a one-off training exercise’. Distributed learning where the training sessions are spaced out over several days is more efficient than massed practice which limits the maximum practical distance between the trainees and the simulation centre [6]. Fortunately, two trainees can share a simulator (dyad training) and a busy (and expensive) consultant does not need to be present at all times [7]. Directed, self-regulated learning where the trainees are allowed to make their own experiences and learn from their mistakes can improve retention compared with instructor-led training [8]. No matter how the training L. Konge [email protected]