Introducing off-the-job training to cardiovascular surgical residency training: a new era of developing competent cardiovascular surgeons.

PURPOSE: This review summarizes the recent progress made in understanding the skill acquisition process of achieving expert status in various fields that require fine motor skills. We discuss the attempts to apply this progress to develop competent surgeons.

METHODS: We reviewed the existing literature, using the keywords "surgical training", "skill acquisition", and "simulator-based training", using Medline, as well as recent books and chapters related to these issues. We also summarized the role of simulator-based training in basic skill acquisition through deliberate practice. Other aspects of surgical skills, such as steps taken to improve motor skills, technical skill in the operating room, and competency level from novice to expert, were reviewed.

RESULTS: The common element of practice to develop top-ranking experts in various fields is deliberate practice. Long-term repetitive practice is supported by the individual's mental attitude: guts, resilience, initiative, tenancy (GRIT). GRIT can be imparted using a teaching method that supports a "growth mindset".

CONCLUSIONS: Recent theoretical advances in skill acquisition can be applied to surgical residency training, while intense efforts are being made to improve the curriculum and training environment.