Training competent minimal access surgeons: review of tools, metrics, and techniques across the spectrum of technology.

Technology has transformed the face of surgical technique among the disciplines of surgery. This revolution has created a strong demand from the public for the availability of minimally invasive surgical (MIS) interventions. Significant pressure has been placed on both industry and medicine to develop, test, and implement devices and procedures at a rapid pace. Unfortunately, this pace has at times surpassed the system's ability to train and prepare a corps of surgeons competent in both the technical and cognitive aspects of minimal access surgery. The economic constraints of surgical practice, coupled with recently introduced work-hour restrictions, have made the delivery of minimally invasive surgical education a challenging endeavor. Much work has been done in academic and private institutions to address this need. Solutions traversing the spectrum of technology have been developed, tested, and implemented in training. The purpose of this review is to highlight these solutions on the basis of their validity, utility, and overall contribution toward achieving the goal of producing competent minimally invasive surgeons. The body of literature suggests multiple valid training and assessment constructs exist. However, the overall utility of many validated "high-end" training technologies is limited by cost and access. Efforts should be aimed at creating valid training and assessment paradigms that can be applied by the broadest group of trainees, from medical students to surgeons, in active practice.