Proficiency-Based Training for Surgical Skills

Considerable national emphasis has been placed on surgical skills training using simulators in an effort to improve surgical education and patient safety. Best methods are being developed but have not been widely adopted. Proficiency-based training obviates the need for allocating predetermined amounts of time for practice and focuses solely on performance. This strategy is more relevant to the desired effect of training and integrates known science in nonsurgical domains regarding skill development. Implementing structured curricula based on proficiency levels derived from expert performance on validated simulators has proven feasible. Proficiency-based training maximizes efficiency by using goal-directed, deliberate practice in a self-practice fashion. Moreover, by requiring trainees to reach a specified level of performance, a uniform skill set is achieved for all trainees. These strategies are applicable to resident education in the skills laboratory environment, and in the future, proficiency standards may play an increasing role in the credentialing of practicing surgeons. (C) 2008 Elsevier Inc. All rights reserved.