Integrating simulation in surgery as a teaching tool and credentialing standard.

The time-honored training methods of surgery are rapidly being replaced with new teaching tools that are being integrated into residency and recredentialing standards. Numerous factors including societal, professional, and legal have all forced surgical training programs to seek alternative methods of training residents. Learning theories that have provided the basis for open surgical skills training have been modified and culminated in the theory of automaticity and the "pretrained" laparoscopic novice. A vast array of simulators exist for training, ranging from inanimate video trainers, human patient simulators, to more recently virtual reality (VR) computer-based trainers. Currently, inanimate trainers are deployed widely throughout surgical training programs and serve as the primary platform for laparoscopic skills training. As technology evolves, VR systems have become available, allowing for more complex skills training with realistic computer-generated anatomic structures. Using the theories of crisis management and crew resource management, simulation is moving from simple skills training to whole-team training in mock operating room environments. Looking to the near future, medical training will continue to evolve to meet the changing demands of society and professional responsibility to ensure patient safety. With the advent of accredited skills-training centers endorsed by the American College of Surgeons, simulation will be the catalyst for these continuing changes.