Invited Commentary on “The Role of Anxiety in Simulation-Based Dexterity and Overall Performance: Does It Really Matter?”

Abstract

There is a paradigm shift in the way operative and technical skills are acquired, with the age-old apprentice model giving way to workshop and simulation based learning. Subsequently, the psychomotor skill learned in this way is translated to actual clinical setting. The advent of endoscopic procedures, along with other factors like reduced work hours, ethical concerns, increased patient awareness, and litigation led to increased adoption of these new modalities of learning.1 Moreover, the shift to alternate learning modalities for skill acquisition was accelerated in the aftermath of European Working Time Directive. It resulted in significant reduction of total training hours from 30,000 to 6,000 h.2 This necessitated introduction of optimum training modules and change in the paradigms of skill acquisition. There are many accepted theories about skill development, which form the basis of various skill training modules and workshops. In the apprenticeship-based model, trainees and students acquired the essential skills on the go, imbibing the steps involved in the process unconsciously. In this context, Halsted stressed the importance of graded responsibility in the surgical training. However, one of the drawbacks in the system was lack of standardized steps and scientific basis. The seminal articles by Kopta et al. in 1971 deconstructed the steps involved in the process of skill acquisition based on Fitts’ model. The whole process of skill acquisitions could be knocked down to three essential steps: cognitive, integrative, and autonomous.3 The first component deals with the procedural steps and the knowledge base. Second component consists of integration of the deconstructed movements with the knowledge base with the help of feedback, followed by the final