For surgery residents, the challenges of achieving technical excellence have become greater as the number of hours available to train has been reduced and the range of procedures performed by a vascular surgeon has increased. Medical students spend less time on surgery rotations, so the process of selecting for vascular surgery residencies students who have the potential to develop into excellent technical surgeons has become more difficult. This article by Van Herzeele et al assesses the variation in medical students' performance on nonmedical technical exercises and correlates their psychomotor skill level with performance of a renal angioplasty on a simulator. Their initial proficiency in nonmedical visuospatial and psychomotor tests was predictive of a better performance of renal angioplasty on a simulator. After six sessions of simulator training, most students reached a plateau in improvement. This is important information, primarily because it demonstrates that medical students arrive at a residency training program with variable levels of technical facility, so that a “one size fits all” approach to education, which currently characterizes most surgical education, is unlikely to lead to optimal technical skills acquisition during the residency. The article supports an approach where residents achieve maximal technical proficiency on a simulator by practicing about six procedures, and then advance to patients, in addition to serving for a prescribed time on each rotation. The article is also important for what it does not claim. There is no claim that those with excellent initial psychomotor skills will become better technical surgeons—“isoperformance,” or transfer of skills to the operating room, depends on many other factors and may or may not be correlated with the initial skill level. In addition, the authors do not attempt to determine whether higher initial skill levels are inherent or acquired by practicing other motor skills before medical school. Ericsson has shown that “expert performance” in other fields, particularly athletics and music, is as dependent on the number of hours of practice and that at least 10,000 hours are required, even of a prodigy, to achieve excellence. Further research in the acquisition of technical excellence is critical to our technique-oriented specialty. The acquisition of technical skill must become as important an area of assessment as cognitive ability for surgeons in training. We need to learn how to initially assess skill levels and then develop more effective methods of skills training to enable each resident to reach their maximum technical potential. Visuospatial and psychomotor aptitude predicts endovascular performance of inexperienced individuals on a virtual reality simulatorJournal of Vascular SurgeryVol. 51Issue 4PreviewThis study evaluated virtual reality (VR) simulation for endovascular training of medical students to determine whether innate perceptual, visuospatial, and psychomotor aptitude (VSA) can predict initial and plateau phase of technical endovascular skills acquisition. Full-Text PDF Open Archive