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Invited Commentary
September 2017

Realism in Simulation: How Much Is Enough?

Author Affiliations
  • 1Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
  • 2The Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Surg. 2017;152(9):825-826. doi:10.1001/jamasurg.2017.1086

Surgical training has long focused on acquiring technical skills. Without doubt, technical skills are essential for the delivery of safe, competent surgical care. Recent studies1 have demonstrated that surgeons with better technical skills have better patient outcomes than their more challenged colleagues. Over the past decade, however, evidence suggests that technical proficiency is not sufficient and that surgeons must also possess nontechnical skills, such as teamwork, leadership, situational awareness, and decision making, that appear equally critical for attaining surgical mastery.2 Much like technical skills, these nontechnical skills can be learned, and there is increasing evidence that this skill acquisition can be enhanced using simulations.3 Simulations provide many benefits compared with learning in the clinical arena, including offering more time for debriefing, reflection, and assessment. Specifically, experience with low-frequency, high-acuity events can be gained without placing patients in danger. Several validated curricula have been developed to guide such training.4

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