The evolution of surgical skills simulation education: Advanced laparoscopic skills

The rapid evolution of modern surgical practice has dramatically expanded the technical skills required of surgical trainees and faculty. Today's surgeons must be proficient in a wide range of techniques, from open to robotic surgery. As the demands of the field grow, training programs face increasing pressure to provide comprehensive education while ensuring high standards in skill development and assessment. To meet these challenges, surgical simulation curricula designed with the principles of educational science offer a critical solution, providing a structured and effective framework for teaching and evaluating these competencies. Over the past 2 decades, several proficiency-based curricula have been developed and implemented to establish a minimum standard and reduce inconsistencies in surgical training. The Society of American Gastrointestinal and Endoscopic Surgeons introduced the Fundamentals of Laparoscopic Surgery, a curriculum for fundamental skills in laparoscopic procedures. In addition, Society of American Gastrointestinal and Endoscopic Surgeons developed the Fundamentals of Endoscopic Surgery and Fundamental Use of Surgical Energy to address endoscopic and electrosurgery skills. Additional curricula such as The Fundamentals of Robotic Surgery and Emerging Minimally Invasive Gynecologic Surgery address skills fundamental to robotic and gynecologic surgery. However, these curricula do not address variability in training at more advanced levels of skills required of senior residents and fellows. This gap was highlighted in a nationwide survey of fellowship program directors and fellows, which underscored the need for improved training in laparoscopic skills, specifically laparoscopic suturing. In order to address this need, the Association of Surgical Education launched the Advanced Training in Laparoscopic Suturing curriculum in 2022. Validity evidence has been established to support the broad adoption of this curriculum, and efforts are underway to disseminate it broadly. This article discusses the need for robust development of surgical skills curricula on the basis of the evolution of clinical surgical practice and provides a brief description of a curriculum development process and validity evidence for 1 such expert-based curriculum. We believe that it can be used as a framework for development of other expert-based training curricula to ensure that trainees universally achieve the necessary skills to maintain high standards of patient safety and care upon completion of training.