title: Evaluation of surgical training in the era of simulation.
abstract: OBJECTIVE
  To assess where we currently stand in relation to simulator-based training within modern surgical training curricula.
  
  
  METHODS
  A systematic literature search was performed in PubMed database using keywords "simulation", "skills assessment" and "surgery". The studies retrieved were examined according to the inclusion and exclusion criteria. Time period reviewed was 2000 to 2013. The methodology of skills assessment was examined.
  
  
  RESULTS
  Five hundred and fifteen articles focussed upon simulator based skills assessment. Fifty-two articles were identified that dealt with technical skills assessment in general surgery. Five articles assessed open skills, 37 assessed laparoscopic skills, 4 articles assessed both open and laparoscopic skills and 6 assessed endoscopic skills. Only 12 articles were found to be integrating simulators in the surgical training curricula. Observational assessment tools, in the form of Objective Structured Assessment of Technical Skills (OSATS) dominated the literature.
  
  
  CONCLUSIONS
  Observational tools such as OSATS remain the top assessment instrument in surgical training especially in open technical skills. Unlike the aviation industry, simulation based assessment has only now begun to cross the threshold of incorporation into mainstream skills training. Over the next decade we expect the promise of simulator-based training to finally take flight and begin an exciting voyage of discovery for surgical trainees.
authors.affiliation: Shazrinizam Shaharan, National Surgical Training Centre, Department of Surgical Affairs, Royal College of Surgeons Ireland, Dublin 2, Ireland.
authors.forename: Shazrinizam
authors.initials: S
authors.lastname: Shaharan
authors.affiliation: Shazrinizam Shaharan, National Surgical Training Centre, Department of Surgical Affairs, Royal College of Surgeons Ireland, Dublin 2, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Neary
keywords: Assessment; Objective Structured Assessment of Technical Skills; Observational tool; Simulation; Skill assessment; Surgery; Surgical skills; Surgical training; Training