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Invited Commentary
June 2017

Surgical Training to Proficiency: Learning From Errors

Author Affiliations
  • 1Department of Surgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Clinical Challenge and CME Editor, JAMA Surgery
JAMA Surg. 2017;152(6):588. doi:10.1001/jamasurg.2017.0104

Training to become effective clinicians historically followed an apprentice model, which required that clinicians provide patient care before they are proficient. Simulation provides opportunities for training of skills in a controlled environment for experiential learning and deliberate practice in a fashion that eliminates risk to patients. Furthermore, structured evaluation of clinical performance can be accomplished in a controlled manner. The advantages of providing training in a simulated environment are obvious and can include the ability to control exposure and training variables, standardization of curriculum, adaptation to various levels of sophistication and complexity, and experiences that are free of risk to patients.1 One such structured curriculum is the Advanced Surgical Skills for Exposure in Trauma (ASSET) course. This course provides trainees with experience in performing emergency procedures for which they may have little experience. Although it is known that individual surgical skills are highly variable and that ASSET training is generally effective,2 the long-term retention of this training and the ability to identify trainees who may have difficulty acquiring or retaining these skills, to our knowledge, have not been previously reported.