Global surgical simulation education, current practices, and future directions.

The traditional apprenticeship model of "see one, do one, teach one" is no longer considered the most effective approach for training surgical trainees. Key factors such as patient safety, increasing trainee numbers, and clinician workload pose significant challenges to surgical training. These pressures have led to the adoption of simulation-based education as an effective adjunct to clinical experience when training future surgeons. The goal of simulation is to provide a controlled, real-life-like environment where trainees can practice and enhance both technical and behavioral or "nontechnical skills" through deliberate practice and structured feedback. In addition to improving psychomotor skills, simulation can also allow health care providers to "rehearse" rare or complex surgical procedures and should also be leveraged to teach behavioral skills such as communication, teamwork, and decision-making. Telesimulation, which is the use of the internet to connect simulation instructors and trainees in remote locations for simulation-based medical education along with virtual and augmented reality, offers cost-effective alternatives to physical simulation spaces. Although simulation-based education is widely used in high-income countries for surgical training, it remains underused in low- and middle-income countries, where surgical education still relies largely on didactic methods, bedside teaching, and intraoperative learning. As a result, a significant opportunity is being missed to use simulation as an educational tool in low- and middle-income countries. The barriers to adopting and scaling up simulation-based education in these regions include the absence of context-specific simulation curricula, competing clinical priorities, limited resources for capacity building, a lack of skilled simulation instructors, and inadequate financial support to establish, equip, and maintain simulation centers staffed by trained experts. Collaborations between academic institutions in high-income countries and low- and middle-income countries have helped overcome some of these obstacles. These partnerships have facilitated the training of local faculty to use simulation effectively for teaching clinical skills and the acquisition of grants to build simulation centers, purchase affordable simulation equipment, and hire personnel.