Teaching technical skills to surgical residents: a survey of empirical research.

We review a series of empirical studies on the use of simulators and bench models in training technical skills and subsequent retention of those skills. We discuss recent research on the transfer of training from bench models and simulators to the clinical setting and provide a theoretical structure to organize the findings. The transfer of training from inanimate bench models and simulators to live patients has recently been demonstrated in a number of areas. The effectiveness of this training is enhanced if focus is placed on the operative, or process-oriented, aspects of the procedure, with suspension of disbelief regarding the physical structure of the training platform. The retention of trained skills is an area of research only beginning to evolve, with recent results suggesting that effective retention can be demonstrated if training is tightly focused and involves an entire procedure. An emerging area of research involves the use of simulators as assessment instruments for high-stakes testing, and recent results involving simulated trauma management support this novel application. Based on these findings, we encourage the use of a wide variety of high- and low-fidelity platforms, with emphasis on training procedural knowledge involving an entire procedure.