This commentary explores the role of simulation in surgical education, including its potential impact on the design of new training models.

Unprofessional behavior by clinicians poses definite patient safety threats, but most research in this area has focused on identifying and addressing disruptive behavior in the work environment. This randomized study raises the concern that physician behaviors outside of work can impair work performance. Significant worsening of simulated surgical performance was found when subjects (students and attending physicians) drank alcohol until intoxication the night before performing procedures. The authors of this study recommend that consideration be given to establishing formal recommendations for alcohol consumption prior to operating room duties. Lack of sleep prior to performing surgery has also been associated with surgical complications, and in fact, intoxication and sleep deprivation have been shown to have similar detrimental effects on physicians' cognitive performance.

Performance of warm-up exercises appeared to reduce the negative effects of fatigue on surgical skills.

Previously presented as a hands-on course, this article summarizes how to develop a training program that uses both physical and computerized simulation.

The author advocates a more balanced approach to understanding the nature of surgical error, positing that the current trend for a systems approach ignores the actual error and individual accountability.