title: Simulation in surgery: what's needed next?
abstract: OBJECTIVE
  To review the current state of simulation use in surgery and to offer direction for future research and implementation of evidence-based findings.
  
  
  BACKGROUND
  Simulation-based training (SBT) in surgery has surged in recent years. Although several new simulators and curricula have become available, their optimization and implementation into surgical training has been lagging.
  
  
  METHODS
  Members of the Association for Surgical Education Simulation Committee with expertise in surgical simulation review and interpret the literature and describe the current status of the use of simulation in surgery, identify the challenges to its widespread adoption, and offer potential solutions to these challenges. The review focuses on simulation research and implementation of existing knowledge and explores possible future directions for the field.
  
  
  RESULTS
  Skill acquired on simulators has repeatedly and consistently been demonstrated to transfer to the operating room, and proficiency-based training maximizes this benefit. Several simulation-based curricula have been developed by national organizations to support resident training, but their implementation is lagging because of inadequate human resources, difficult integration of SBT into educational strategy, and logistical barriers. In research, lack of coordinated effort, flaws in study design, changes in simulator-validation concepts, limited attention to skill retention, and other areas are in need of improvement.
  
  
  CONCLUSIONS
  Future research in surgical simulation should focus on demonstrating the cost-effectiveness of SBT and its impact on patient outcomes. Furthermore, to enable the more widespread incorporation of best practices and existing simulation curricula in surgery, effective implementation strategies need to be developed.
authors.affiliation: *Department of Surgery and Carolinas Simulation Center, Carolinas Healthcare System, Charlotte, NC †Department of Surgery and Cancer, St Mary's Hospital, Imperial College of London, London, UK ‡Department of Surgery, LSU Health New Orleans School of Medicine, New Orleans, LA §Department of Surgery, University of Toronto, Ontario, Canada ¶Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA ‖Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.forename: John
authors.initials: J
authors.lastname: Paige
authors.forename: Boris
authors.initials: B
authors.lastname: Zevin
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Teodor
authors.initials: T
authors.lastname: Grantcharov
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D018961:Educational Technology / Q000639:trends*; D005180:Faculty, Medical / Q000600:supply & distribution; D013502:General Surgery / Q000193:education*; D006801:Humans; D008953:Models, Anatomic; D010348:Patient Care Team; D014481:United States