Given the success of simulator training of airline and military personnel, it has the potential to have a major impact on surgical training paradigms. With surgical simulators, a trainee s first distal anastomosis in an actual patient will occur only after mastering the technique on a simulator.1264 The mastery of basic skills will allow the trainee to focus on more complex tasks as well as to understand the conduct of the operation more thoroughly and quickly. The fundamentals of simulator training are based on the learning principle of deliberate practice, in which an individual practices a finite task until it is mastered. Still, before this method of training can be incorporated into a formal curriculum, several issues must be addressed. Trainees must have adequate supervision and instruction to ensure appropriate technique, which will require that attending surgeons have time away from clinical and academic duties to provide simulator training. This poses a considerable challenge under current reimbursement re- quirements, and a reimbursement system that provides an incentive to active surgeons to teach residents in the simula- tion laboratory will be required. As an alternative, training programs may opt to hire recently retired surgeons to teach in the simulation laboratory. Finally, simulators must become more robust, with perhaps computer-enhanced clinical sce- narios, before the residents who train on them are qualified to care for patients. 