For centuries, surgery has been taught using an apprenticeship model. As Atesok et al1 explain in their timely and thoughtful review in this issue of the Journal of the American Academy of Orthopaedic Surgeons, surgical skills training will change dramatically in the coming years, toward more objective, proficiency-based approaches. This transformation will improve patient safety and educational efficiency. Structured curriculum, surgical simulation, and objective assessment of technical proficiency will be critical parts of this change. In their up-to-date and comprehensive book, Gallagher and O'Sullivarr provide an excellent overview of the background and rationale for this paradigm shift, which has been largely pioneered in nonorthopaedic procedural specialties. It is a very good reference for those interested in the principles of simulation training and objective assessment of proficiency.
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