Objective assessment of technical performance.

Technical skills are essential to the practice of surgery. They can be taught in the operating room and in the surgical skills laboratory. The use of simulators allows the development of reproducible curricula with measurement of performance using objective metrics. The goal of those designing metrics for the simulation laboratory should be to establish measures that are consistent with those of high quality surgery in the operating room. Once these metrics have been shown to be reliable, valid, practical to use, and meaningful to the learner, they can form the basis of a learning program based on the acquisition of proficiency. Performance in the skills laboratory should ultimately be predictive of performance in the clinical setting.