9
Abstract
Introduction
Simulation-based education has become an essential component of
modern surgical training. We aimed to evaluate the current state of
simulation in surgical education and its impact on clinical outcomes, and
potential future direction for enhancing its role in surgical training.
Methods
We utilized a comprehensive approach to examine the current role of
simulation-based education in surgical training. A systematic search
of relevant literature was conducted across major databases using a
combination of keywords.
Results
Across multiple studies, simulation improved both the acquisition and
retention of surgical skills. There was also a positive correlation with
patient outcomes, e.g. reduction in operative times, enhancement of
procedural accuracy, and decrease in intraoperative and postoperative
complications. Specialty-specic applications of simulations improved
technical skills and condence, procedural speed, and overall
performance in vascular, orthopedic and transplant surgery. We also
found barriers to implementation and widespread adoption of simulation
in surgical education that included high costs, resource limitations, lack
of simulation validation to real world scenarios, and lack of complete
curriculum development.
Conclusion
The integration of simulation into surgical education has proven to be
a critical step in overcoming the challenges posed by modern surgical
training and provides a structured, risk-free environment for trainees to
develop both technical and non-technical skills, while also maintaining
competency over time. Despite the benets, there are still signicant
barriers to the widespread adoption of simulation in surgical training that
must be addressed to fully realize the potential of simulation in improving
surgical training and patient outcomes.
Resumen
Introducción
La educación basada en simulación se ha convertido en un componente
esencial de la formación quirúrgica moderna. Nuestro objetivo fue
evaluar el estado actual de la simulación en la educación quirúrgica, su
impacto en los resultados clínicos y las posibles direcciones futuras para
mejorar su papel en la formación quirúrgica.
EDITORIAL
THE ROLE OF SIMULATION IN SURGICAL EDUCATION:
CURRENT PRACTICES AND FUTURE DIRECTIONS
SIMULACIÓN Y EDUCACIÓN EN CIRUGÍA GENERAL:
PRÁCTICAS ACTUALES Y DIRECCIONES FUTURAS
1 Departamento de Cirugia General, Cedars-Sinai
Medical Center, Los Angeles, CA 90048, USA
ORCID ID:
Adam Surti:
orcid.org/ 0000
Robert Matthews:
orcid.org/ 0000
Rodrigo F. Alban:
orcid.org/ 0000-0001-5394-3836
*Corresponding author: Rodrigo F. Alban
E-mail: Rodrigo.Alban@cshs.org
Adam Surti1, Robert Matthews1, Rodrigo F. Alban1*
Este artículo está bajo una
licencia de Creative Com-
mons de tipo Reconocimien-
to – No comercial – Sin obras
derivadas 4.0 International.
Received: 30 – Ago – 2024
Accepted: 09 – Dec – 2024
Publish: 01 – Jan – 2024
Article history
Conflict of interest: The authors were free to
prepare the manuscript and there were no potential
conicts of interest.
CRediT – Contributor Roles Taxonomy:
Conceptualización, Curación de datos, Análisis formal:
RFA, AS, RM; Investigación, Metodología, Visuali-
zación, Redacción – borrador original, Redacción –
revisión y edición: RFA, AS, RM.
Financial disclosure: The authors have no nan-
cial relationships relevant to this article to disclose.
Palabras clave: Educación quirúrgica, Simulación
en la formación, Simulación quirúrgica
Keywords: Surgical education, Simulation in trai-
ning, Surgical simulation
DOI: 10.48018/RMVv35i1e
Revista Médica Vozandes
Volumen 35 , Número 2, 2025
Citation: Surti A, Matthews R, Alban R. The
Role of Simulation in Surgical Education:
Current Practices and Future Directions.
Med Vozandes. 2024; 35 (2): 9 - 13
10
Resources, curriculum design, and the long-term
benets of simulation require further research and
development4. This manuscript aims to evaluate the
current state of simulation in surgical education, the
methods employed in its implementation, and its impact
on clinical outcomes, while also exploring the barriers to
widespread adoption and potential future direction for
enhancing its role in surgical training.
METHODS
This review utilizes a comprehensive approach to examine
the current role of simulation-based education in surgical
training. A systematic search of relevant literature was
conducted across major databases, including PubMed,
Google Scholar, and MEDLINE, using a combination
of keywords such as “surgical simulation”, “surgical
education”, “surgical skills”, “transplant surgery simulation”,
and “technical skills training”. The search was restricted to
articles published in the last 15 years to ensure the inclusion
of the most recent and relevant ndings in the eld.
Inclusion criteria for this review consisted of original
research articles, meta-analyses, and systematic reviews
that specically evaluated the impact of simulation-based
INTRODUCTION
Simulation-based education has become an essential
component of modern surgical training, providing
opportunities for skill development, renement,
and assessment in a risk-free environment. Over
the past two decades, simulation has evolved from
simple anatomical models to sophisticated virtual
reality simulators. This transformation has signicantly
enhanced the learning process for surgical trainees,
allowing them to practice complex procedures before
stepping into the operating room.
The need for simulation-based training arises from
increasing demands on surgical education, which
include restricted working hours, reduced patient
exposure, and the complexity of modern surgical
procedures1. Traditional apprenticeship models,
while effective, are no longer sufcient to meet these
challenges. Studies have consistently shown that
simulation improves not only technical prociency but
also the retention of skills, thereby preventing the decay
of skills that often occurs in low-exposure environments2.
Simulation-based education has also demonstrated a
positive impact on patient safety by allowing trainees
to gain condence and precision in their techniques
before performing on actual patients1,3.
Despite these advancements, gaps still exist in
integrating simulation into routine surgical curricula.
THE ROLE OF SIMULATION IN SURGICAL EDUCATION:
CURRENT PRACTICES AND FUTURE DIRECTIONS Surti A, et al.
Revista Médica Vozandes
Volumen 35 , Número 2, 2025
Métodos
Utilizamos un enfoque integral para examinar el papel actual de la
educación basada en simulación en la formación quirúrgica. Se realizó
una búsqueda sistemática de la literatura relevante en las principales
bases de datos utilizando una combinación de palabras clave.
Resultados
En múltiples estudios, la simulación mejoró tanto la adquisición como
la retención de habilidades quirúrgicas. También hubo una correlación
positiva con los resultados de los pacientes, por ejemplo, reducción de
los tiempos operatorios, mejora de la precisión de los procedimientos y
disminución de las complicaciones intraoperatorias y postoperatorias. Las
aplicaciones especícas de especialidad de las simulaciones mejoraron
las habilidades técnicas y la conanza, la velocidad de los procedimientos
y el rendimiento general en cirugía vascular, ortopédica y de trasplante.
También encontramos barreras para la implementación y adopción
generalizada de la simulación en la educación quirúrgica, que incluían
altos costos, limitaciones de recursos, falta de validación de la simulación
en escenarios del mundo real y falta de desarrollo completo del currículo.
Conclusión
La integración de la simulación en la educación quirúrgica ha
demostrado ser un paso crítico para superar los desafíos que plantea la
formación quirúrgica moderna y proporciona un entorno estructurado
y sin riesgos para que los aprendices desarrollen tanto habilidades
técnicas como no técnicas, al tiempo que mantienen la competencia
a lo largo del tiempo. A pesar de los benecios, todavía existen barreras
signicativas para la adopción generalizada de la simulación en la
formación quirúrgica que deben abordarse para aprovechar al máximo
el potencial de la simulación en la mejora de la formación quirúrgica y
los resultados de los pacientes.
11
EDITORIAL
Revista Médica Vozandes
Volumen 35 , Número 2, 2025
education on the development of technical and non-technical
skills in surgical trainees. Studies examining the effects of different
simulation modalities, such as virtual reality, haptic feedback
systems, and physical models were included. Articles that discussed
the transfer of skills from simulation to clinical practice, patient
outcomes, and the barriers to integrating simulation into surgical
curricula were also selected. Studies not focused on surgical
education or simulation-based interventions were excluded.
A thematic analysis was conducted to categorize studies based
on their focus areas, including the type of simulation used, surgical
specialty, and clinical outcomes. The ndings were synthesized
to identify common themes related to the effectiveness of
simulation, its implementation challenges, and future directions
for improving its adoption in surgical education. Data was also
extracted on resource allocation, curriculum development, and
trainee performance metrics where applicable.
RESULTS
The literature review identied several key ndings regarding the
effectiveness and challenges of simulation-based education in
surgical training. Across multiple studies, simulation was shown
to signicantly enhance both technical and non-technical
skills in surgical trainees, which translated into improved clinical
performance and patient outcomes.
1. Skills Acquisition and Retention
A number of studies conrm the role of simulation in both the
acquisition and retention of surgical skills. Higgins et al.2 found
that simulation signicantly reduces the decay of procedural
skills, a major issue in low clinical exposure environments.
Siu et al.5 further highlighted that robotic surgery simulation
allows trainees to gain prociency in complex procedures
before performing on actual patients. Additionally, Agha and
Fowler6 reviewed the overall role of simulation in maintaining
technical skill levels and improving readiness for real-world
surgical environments, concluding that simulation improves
trainee learning and has the potential to meet the needs of
the surgical profession.
2. Impact on Patient Outcomes
Simulation not only enhances trainee performance, but
also shows a positive correlation with patient outcomes.
One meta-analysis demonstrated that simulation training
reduces operative times and enhances procedural accuracy,
contributing to improved patient outcomes1. Other studies
found that skills acquired on simulators have consistently been
shown to transfer to the operating room and have the potential
to improve patient outcomes2,3. Further, a randomized control
trial by Zendeas et al.7 evaluated resident performance during
a totally extraperitoneal (TEP) inguinal hernia repair with a
simulation-based curriculum vs standard practice and found
decreased operative times, improved operative scores, and
decreased intraoperative and postoperative complications for
the simulation trained group.
3. Specialty-Specic Applications
Simulation is increasingly being applied across
surgical specialties. In vascular surgery, Pantoja
et al.8, found that simulation-based training in
open aneurysm repair helped trainees build both
technical skills and condence. Beaudoin et al.9,
demonstrated that simulation-based training,
particularly in arthroscopic surgery, improved
procedural speed, camera path accuracy, and
overall performance in untrained participants.
Transplant surgery has also beneted from
specialized simulation models. For example, high-
delity, tissue-based porcine models have been
used to teach cardiac transplantation, including the
complex steps of organ procurement, anastomosis,
and implantation under cardiopulmonary bypass10.
Further, similar models have been incorporated in
solid organ transplantation training, where residents
practiced multi-organ procurement and kidney
transplantation with signicant improvements in
their technical skills11.
4. Barriers to Implementation
Despite its benets, several studies identied
signicant barriers to the widespread adoption
of simulation in surgical education. High costs
and resource limitations were frequently
cited. Zevin et al.4, emphasized the need for
standardized curricula to ensure consistent
outcomes, while Agha and Fowler6, noted the
importance of validating simulation models
to replicate real-world scenarios effectively.
Rangarajan et al.12, pointed out that while virtual
haptics show promise, more research is needed
to fully integrate it into training programs. These
barriers highlight that coordinated efforts in
resource allocation and curriculum development
are necessary for broader adoption.
DISCUSSION
The integration of simulation into surgical
education has proven to be a critical step in
overcoming the challenges posed by modern
surgical training, such as limited operative
exposure and the increasing complexity of
procedures. Across specialties, simulation provides
a structured, risk-free environment for trainees to
develop both technical and non-technical skills,
while also maintaining competency over time.
One of the greatest strengths of simulation-based
education is its ability to provide immediate,
structured feedback during practice, allowing
trainees to continuously rene their skills. Unlike
traditional learning environments, simulation
offers the opportunity to practice complex
12
delity simulators, lack of standardized curricula, and
the need for validation of models continue to hinder its
broader integration. Addressing these challenges will
be critical to fully realizing the potential of simulation in
improving surgical training and patient outcomes.
Looking forward, the future of simulation in surgical
education is promising. Emerging technologies such as
virtual reality and patient-specic simulations are likely
to play an increasingly prominent role. For simulation to
reach its full potential, a collaborative effort is needed to
ensure greater access to resources, validation of models,
and development of standardized curricula that can be
applied across institutions.
surgical procedures repeatedly in a controlled setting,
with real-time feedback from instructors or the system
itself. This continuous feedback loop improves technical
precision, decision-making, and condence, leading to
higher competency when transitioning to live surgeries.
Furthermore, these skills can be learned and maintained
even when clinical exposure is limited. This is particularly
critical in environments where opportunities for hands-
on surgical practice are restricted, such as the COVID-19
pandemic.
However, despite the benets, there are still signicant
barriers to the widespread adoption of simulation in
surgical training. Issues such as the high cost of high-
Revista Médica Vozandes
Volumen 35 , Número 2, 2025
THE ROLE OF SIMULATION IN SURGICAL EDUCATION:
CURRENT PRACTICES AND FUTURE DIRECTIONS Surti A, et al.
Table 1: List of studies in surgical simulation and education organized by them
Theme Article Author Year
Skills Acquisition and Retention
Agha RA et al The role and validity of surgical simulation. International
surgery.
Agha 2015
Higgins et al. Development and decay of procedural skills in surgery:
A systematic review of the effectiveness of simulation-based medical
education interventions. Surgeon.
Higgins 2021
Siu et al. Robotic surgery: Human learning, simulation and training on
surgical education. Front Surg.
Siu 2022
Impact on Patient Outcomes
Stefanidis et al Association for Surgical Education Simulation Commit-
tee. Simulation in surgery: what’s needed next? Ann Surg.
Stefanidis 2015
Meling et al. The impact of surgical simulation on patient outcomes: a
systematic review and meta-analysis. Neurosurg Rev.
Meling 2021
Higgins et al. Development and decay of procedural skills in surgery:
A systematic review of the effectiveness of simulation-based medical
education interventions. Surgeon.
Higgins 2021
Speciality-Specic Applications
Golriz et al Pig as an animal model for liver surgery and transplantation.
Hepatobiliary Pancreat Dis Int.
Golriz 2020
Pantoja et al Trainee Experience in Simulation-Based Education of
Open Vascular Surgery. Ann Vasc Surg.
Pantoja 2021
Beaudoin et al. Module-Based Arthroscopic Knee Simulator Training
Improves Technical Skills in Naive Learners: A Randomized Trial. Arthrosc
Sports Med Rehabil
Beaudoin 2021
Gladden A, Westbrook E, Charco R, Kumar G, Solga S. Use of tissue-
based porcine models for open and laparoscopic vascular surgery
training: A multicenter experience.
Gladden 2021
Barriers to Implementation
Zevin et al. A consensus-based framework for design, validation, and
implementation of simulation-based training curricula in surgery. J Am
Coll Surg.
Zevin 2012
Agha RA et al The role and validity of surgical simulation. Internatio-
nal surgery.
Agha 2015
Systematic review of virtual haptics in surgical simulation: a valid edu-
cational tool?. J Surg Educ.
Rangarajan 2020
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EDITORIAL
Revista Médica Vozandes
Volumen 35 , Número 2, 2025
