“evolution can progress more productively when education and training are updated to reflect the technology that is being implemented in medical practice”.

The articles in this issue deal with new technologies or how new technologies may be used to enhance education and training. Technological advances are rapid and continuous. As Paul Wetter mentions in his article we will move to ‘non surgery’ by using molecular energy technology which will allow us to heal patients at the individual cell level within the next few decades or sooner. The open surgery simulator article discusses virtual reality simulation which gives students the opportunity to hone their skills in a risk free environment while enhancing psychomotor skills. The in situ code blue training fosters interprofessional development across disciplines. All excellent methods to ensure skills development, assess student and doctors capabilities while in no way endangering patients.

There is no question that technology is going to enhance education and training. As Claire Topal so articulately states, “evolution can progress more productively when education and training are updated to reflect the technology that is being implemented in medical practice”. She further suggest having “a seminal report that examines physician training in a rigorous way - including how to systematically implement specific training methods and evidence on what does and does not work in different contexts “ and as she states, “… could make an enormous impact on medical education”.

Throughout MEdSim publications we have discussed different methods that enhance education and training: simulation, virtual reality Team Stepps, checklist, team training, to name a few, but these are all just tools that enhance education and training. As Topal suggests, a comprehensive study would answer many questions.

The curricular transformation promotes professionalism and institutional cultural change and even lifelong learning by presenting new opportunities to incorporate professional education at all levels. Inter-professional development is being implemented in medical schools, hospitals and throughout residency programs. This still does not address the ‘elephant in the room’ problem. At all levels there is a pervasive cultural question. When does the student admit they do not know something and ask for help?

This is not unique to healthcare. However, it is far more crucial in healthcare and other high risk environments. The individual/s need to be in an environment that supports inquiry, if the ultimate goal is to maximize performance.

There have been several recent articles online dealing with medical suicides. In an April, 2014 article by Pranay Sinhasept, a resident, which was on line on May 25, 2015, he discussed the pressure residents face in the transformation from medical school to intern (1st Year) and residency. He states that “. . . while hospitals and residency programs are aware of the physical and mental stress new residents face and offer confidential counseling, writing workshops and other services to reduce stress,” there is a “strange machismo that pervades medicine. Doctors, especially fledgling doctors like me, feel pressure to project intellectual, emotional and physical prowess beyond what we truly possess. Despite the support of my supervisors, my first two months were marked by severe fatigue, numerous clinical errors (that were promptly caught by my supervisors), a constant and haunting fear of hurting my patients and an inescapable sense of inadequacy. . . . .”

Healthcare providers at all levels need to be able to voice their doubts and fears and be able to admit mistakes made in an atmosphere of trust and support or as in the airline industry “no fault”. “A safe environment,” so to speak. This is the cultural shift that needs to occur without damage to reputation and in my opinion would foster patient safety and better outcomes.

Simulation offers a unique opportunity to practice in an environment of safety. This helps each individual be as certain as possible they know what to do. But what happens on rounds or in a crisis situation? If they could openly discuss with their colleagues and supervisors would continuous learning not take place?