Distance simulation in surgical education.

Distance and remote simulation have emerged as vital tools in modern surgical education, offering solutions to challenges such as limited operating hours, growing clinical demands, and the need for consistent, high-quality training. This review examines the benefits, limitations, and strategies for implementing sustainable distance simulation, structured around 3 foundational pillars: (1) effective hardware and infrastructure, including simulators and realistic scenarios that enable trainees to develop essential skills; (2) validated training programs grounded in educational theory with a clear focus on skill transfer and predictive validity; and (3) timely access to effective feedback. Distance simulation permits adaptable, scalable training environments, but the addition of remote and deferred feedback has further broadened its impact, helping to overcome the challenges posed by faculty availability and clinician time constraints. Remote-asynchronous feedback not only makes teaching time more efficient but also allows instructors to organize their time flexibly, maximizing their impact. Furthermore, web-based feedback oriented platforms facilitate the creation of a sustainable teaching network through train-the-trainer initiatives, enabling near-peer and nonclinical experts to provide standardized, high-quality teaching. This scalable model reduces the reliance on senior faculty, building a culture of mentorship and support within the surgical education community. In addition, distance simulation platforms are increasingly incorporating artificial intelligence-enhanced assessment tools capable of detecting errors, analyzing procedural steps, and generating automated feedback. Integrating artificial intelligence into innovative simulation modalities not only enhances access to quality feedback but also could provide deeper insights into the learning process, as learners progress through these enriched learning curves. Growing evidence shows how tools for sustainable distance simulation can positively impact education at multiple levels, benefiting undergraduate and postgraduate students, residents, and faculty across a spectrum of skills from basic tasks to complex surgical procedures. Moreover, its applications extend beyond simulated environments, providing frameworks that can be adapted to teach real surgical performance in clinical settings. As surgical education evolves, distance simulation demonstrates immense value in supporting accessible, high-quality training, particularly in resource-limited environments.