A Revitalizing Look at Simulation,Education,and at New Paradigms of Training in Surgery,Robotics,and in the Operating Room

This issue of JLAST highlights new and evolving challenges in simulation, education, and new paradigms of training in surgery, robotics, and in the operating room. The authors invited to address these challenges and tasked to provide the reader with a revitalizing look at simulation and education in surgery are world-expert surgeons and educators. Therefore, the reader will find this special content issue extremely interesting and forward-looking to innovative paradigms of education and training. The common denominator of these articles is that training is evolving at all levels, from the trainees to the nurses, surgeons, and anesthesiologists and that newer paradigms of education, training, and credentialing are needed that could provide value by delivering better outcomes and cost savings.

Schwab and McGaghie from Northwestern University highlight problems with the traditional apprenticeship model of clinical education and advocate for well-designed mastery learning-based and outcome-driven curricula to identify learners in need of remediation. Schwab and McGaghie also point out that institutional support should be essential to have clinical impact that results in improved patient care, outcomes, and cost savings.

Sullivan and Pugh from University of Wisconsin suggest that simulation may be able to replace learning time without compromising the development of clinical competencies. Sullivan and Pugh also suggest that awareness and reflective practice should be encouraged in surgeons and trainees as a way to reduce cognitive and diagnostic errors. Anton and Stefanidis from Indiana University expand on the concepts of Sullivan and Pugh by pointing out that mental skills curricula—focused on energy management techniques, such as relaxation strategies, attention and thought management skills, formalized goal setting, and performance routines—could offer surgeons even greater benefits in performance enhancement, like those observed in athletes, artists, and the military.

Andolfi and Umansky from University of Chicago denounce the lack of standardization in training and certification of robotic surgeons despite the involvement of professional societies, as they point out that objective criteria for proficiency and credentialing in robotic surgery vary among institutions. Andolfi and Umansky therefore call for detailed and standardized processes for credentialing and privileging monitoring.

Finally, Robertson and Smink from Brigham and Women's Hospital are the first to review nontechnical skills in interprofessional OR team training that involves surgery, anesthesia, and nursing. They highlight differences and similarities between the training programs and how unique elements in a program may influence knowledge and behavior changes that would add clinical value and better outcomes.

I thank the contributors for having agreed to share their expertise with the readers of JLAST.