Optimal acquisition and assessment of proficiency on simulators in surgery.

Increasingly, trainees are being exposed to simulators for the purpose of acquiring surgical skills. This article addresses the theoretical framework behind surgical skill acquisition and explores the factors that optimize learning on simulators. Furthermore, this article evaluates the role of currently used performance metrics for documentation of skills proficiency and provides suggestions for the incorporation of additional, more sensitive performance metrics that may lead to improved transfer of simulator-acquired skill.