Proficiency-Based Training Using Simulator-Based Tools Could be Validated for Certification of Surgical Procedural Proficiency.

Airline pilots can learn how to fly without ever leaving the ground, and pilots are required to pass proficiency checks using simulator-based tools to ensure they are competent, and remain competent, to fly specific types of planes under specific circumstances. In contrast, generally, surgical training is based on an apprenticeship model, and surgical certification does not require demonstration of hands-on skills in performing basic, advanced, or subspecialized procedures. Proficiency-based training, or PBT, also known as proficiency-based progression or PBP, is a tool that can be used to train surgeons to safely and efficiently perform surgical procedures. Moreover, PBT, simulators, and similar tools can be used to evaluate a surgeon's proficiency. Ultimately, in the interest of quality, value, and patient safety, objective evaluation of hands-on surgical skill using simulators should be implemented. In the interest of fairness to surgeons, certification must be developed with a goal of not only testing but supporting development of procedural proficiency. As we follow our peers in the airline industry, pathways chosen to validate surgical competence must be evidence-based, fair, and valid.