Training to Proficiency

Many aspects of surgical training have evolved considerably, affecting how we train surgeons to reach and maintain proficiency. Specifically, advancements in disease management and technology have expanded the knowledge and skill base necessary for trainees prompting the development of governing bodies in surgical education. Together with principles of learning psychology, such as Ericsson’s deliberate practice and the Dreyfus educational model, the emphasis on proficiency-based training has grown. An example includes the development of simulation-based training in all modalities of surgery and the demonstration of its impact on both skill acquisition and transferability of skills to the operating room. Indeed ongoing simulation continues to evolve with changes such as the shift from time and repetitions to expert-derived levels and the increasing focus on higher-level patient and clinical outcomes. Further examples such as the development of core competencies, entrustable professional activities (EPAs), and video-based review serve to provide frameworks for ongoing training both within and beyond residency. Given these extraordinary advancements, proficiency-based education is expected to remain a core part of surgical training and expand further into surgical practice.