Implementation of curricula is constantly evolving, supporting improvements in the quality of medical education and clinical practice (Eur J Anaesthesiol 2019;36:473-6). Evolution within medical education in anesthesiology reflects many factors, including changes in the health care environment and the role of the physician, altered societal expectations, rapid advancements in medical sciences, and new training techniques (Trans Am Clin Climatol Assoc 2015;126:260-70). With the continually changing landscape of medicine, where innovation and advancement in technology continue to be the mainstays, medical education has evolved beyond the traditional realms of training. Here, we highlight how simulation-based strategies have advanced and impacted our specialty.

The American Board of Anesthesiology (ABA) Objective Structured Clinical Examination (OSCE) was implemented in 2018, designed in part to assess communication and professionalism skills. It is recognized that unprofessional behavior can negatively impact patient safety, compromise the clinical learning environment, and affect physician well-being – resulting in an erosion of trust and psychological safety (PLoS One 2023;18:e0280444; J Clin Anesth 2024;95:111429). Endorsed by the Accreditation Council for Graduate Medical Education (ACGME), the Milestones 2.0 and the Clinician Educator Milestones competency-based assessment tools provide guidance for departments to train and develop competent physicians who can practice independently and effectively (Anesth Analg 2021;133:353-61). Professionalism, in addition to patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, and systems-based practice, make up the six core competencies that clinicians are expected to advance throughout their training and practice. During the OSCE, board-eligible candidates interact with standardized patients and clinicians in a simulated environment (J Clin Anesth 2021;75:110439). The standardization of administration of the OSCE and uniformity of clinical scenario exposure promote a more objective and comprehensive evaluation of the examinee, especially in combination with the ABA Standardized Oral Examination. Utilizing simulation-based strategies has proven to be effective in the examination process, and many programs are incorporating mock OSCEs and mock orals in simulated environments to prepare their trainees for independent practice.

Simulation, 3D printing modalities, and virtual reality (VR) tools are emerging as novel teaching tools for echocardiography training. Traditional echocardiography learning is limited by access to costly high-fidelity simulators and inadequate evidence of their efficacy. In Jujo’s meta-analysis of transesophageal echocardiography (TEE) simulation curriculums, postintervention tests demonstrated improved skills and knowledge (Simul Healthc 2021;16:341-52). To improve access to simulation learning modalities, Bu et al. developed 3D-printed hearts that could be disassembled along common TTE and TEE planes, providing a cost-effective and portable alternative to expensive, large echo simulators and allowing learners to physically correlate complex cardiac anatomy with key ultrasound imaging planes (J Cardiothorac Vasc Anesth 2023;37:1813-18; J Cardiothorac Vasc Anesth 2023;37:1026-31).

In addition, rapid progression in technology has made VR much more accessible and cheaper. Though VR may cause motion sickness for users, it is a promising modality, particularly for users without access to costly and large echo simulators (J Cardiothorac Vasc Anesth 2023;37:299-05). With customizable options, augmented VR tools allow for illustration of normal and pathological cardiac anatomy via handheld TTE and TEE “probes,” which offers improved image acquisition and recognition. VR has the advantages of providing a “realistic, dynamic, interactive environment that can be accessed at a distance…[and] the learner’s performance data can be readily analyzed for feedback and assessment” (Anesth Analg 2022;135:220-2). Imagine a VR immersion workshop where anesthesiologists from various parts of the world come together in an augmented reality “room” to learn a specific regional block technique. The instructor can facilitate learning, appearing in the learner’s virtual environment and offering guidance in real time as they develop these hands-on technical skills (Anesth Analg 2022;135:220-2).

As self-directed learning techniques emerge as an effective educational method that interlaces with today’s busy clinical environment, practicing anesthesiologists will seek out resources to further their knowledge and skillset. For anesthesiologists at all levels, high-quality self-directed training programs and certifications abound. ASA’s Diagnostic POCUS Certificate Program focuses on the acquisition and interpretation of diagnostic ultrasound of the heart, lungs, abdomen (stomach and peritoneal cavity), and pelvis – the POCUS organ systems identified by both the ABA and ACGME as core competencies for practicing anesthesiologists. ASA’s new Gastric POCUS Certificate similarly offers online learning modules. For physicians looking to become proficient in basic perioperative transesophageal echocardiography (PTE), the American Society of Echocardiography offers a pathway to certification in basic PTE. ASA and the Society of Cardiovascular Anesthesiologists offer an online Basic Perioperative TEE Program that provides relevant CME, including 100 guided TEE cases and high-quality on-demand lectures.

Two other cutting-edge educational resources for practicing anesthesiologists are ASA’s live MOCA Simulation course and the online PeRLS (Perioperative Resuscitation and Life Support) Certificate Program. The full-day ASA MOCA course (periodically held at ASA-accredited training centers) features numerous high-fidelity simulation scenarios where participants hone their communication, diagnostic, and therapeutic skills, manage critical incidents, and engage in structured debriefings and feedback sessions. This promotes patient safety through team training and refinement of clinical knowledge and skills. ASA’s PeRLS Certificate Program highlights advanced life support involving diagnostic and treatment algorithms unique to the perioperative setting to improve management of such crises.

The landscape for medical education in anesthesiology continues to change as emerging technologies, learner styles, and clinical practice demands necessitate constant reevaluation of effective teaching strategies to train the next generation of anesthesiologists. Given the current exciting trends in utilization of simulation-based tools to complement standard didactic curriculum training, it is even more exciting to imagine what the horizon will look like 10 years from now.