Minimally invasive surgical training solutions for the twenty-first century.

Despite the tremendous impact of laparoscopic cholecystectomy on the practice of surgery over the past 9 years, minimally invasive surgery faces many challenges that must be addressed. SAGES and the American College of Surgeons already have defined guidelines that, if properly implemented, could eliminate most of these challenges. Medical educators must formulate a detailed program as to how these guidelines can be widely deployed with acceptable effectiveness. The current educational philosophies and techniques will not ensure widespread access to a standardized program that would support the achievement of the goals set forth by major surgical governing bodies. Therefore, new educational strategies and techniques that are assisted with the integration of cost-effective technology are needed. Suggested solutions include the deployment of a standardized, objective-based skill-development program that has a large database to evaluate the progress of participants. Next, the Internet, with its ability to transfer content with the click of a mouse, will play an increasing role in distant education. Video and audio streaming techniques will allow the deployment of content previously shackled to a CD-ROM platform. CD-ROM interactive technology also can help in developing clinical judgment with innovative strategies, such as Objective-Based Clinical Competency Evaluation Scenarios. Telecommunications will fuse the components of a coordinated distant learning strategy. Also, telecommunications will allow the availability of new training capabilities in the form of teleproctoring and telementoring to hospitals, no matter what their size or location. All of these components combined enable the realization of a continuing education program in minimally invasive surgery that is readily available to hospitals worldwide. Last, institutions, resident training programs, and individual surgeons must commit the time to partake in these cutting-edge programs for challenges facing us to be completely eliminated. A high priority must be placed on the resolution of these issues.