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ssss1 Graphic representation of an ideal training program, balanced with concern for patient safety. Training starts with simulation task training such as a VALS‐like curriculum until passing competency assessment. Thereafter high‐fidelity models such as training in fresh cadavers takes place, prior to training on a live animal model. After these steps, the trainee should be ready to perform basic MIS procedures on patients, under supervision of an experienced MIS surgeon. Advancing the level of surgeries would ideally start with fresh cadaver exercises followed by practice in a live model, before attempting advanced procedures on animal patients. It is likely that training of a fully competent MIS surgeon, able to safely do advanced procedures on patients, is beyond the goal of ACVS resident training. Training such as ACVS Fellowship may be required to reach that level.

For a program director interested to develop a simulation skills training program, there is vast evidence on best practices. More important than the type of simulation model one has access to is that the practice is deliberate [40]. Expertise is not gained by simply spending time practicing but by engaging in a specific type of practice. The concept of deliberate practice [40] outlines the critical elements of optimal learning, that is, tasks with (i) well‐defined goals, (ii) motivation to learn, (iii) feedback, and (iv) opportunities for repetition and refinement.