1. Date of download: 5/30/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Computers and Virtual Reality for Surgical Education in the 21st Century Arch Surg. 2000;135(7):786-792. doi:10.1001/archsurg.135.7.786 Pyramid model of compounding technology. Newer technology requires different and more remote surgical skills. Figure Legend:

2. Date of download: 5/30/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Computers and Virtual Reality for Surgical Education in the 21st Century Arch Surg. 2000;135(7):786-792. doi:10.1001/archsurg.135.7.786 Yerkes-Dodson law. Environments of low or high stress are suboptimal for learning and performance. Figure Legend:

3. Date of download: 5/30/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Computers and Virtual Reality for Surgical Education in the 21st Century Arch Surg. 2000;135(7):786-792. doi:10.1001/archsurg.135.7.786 Stepwise model for improved learning environments. More advanced skills are built on a foundation of basic skills. OR indicates operating room. Figure Legend:

4. Date of download: 5/30/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Computers and Virtual Reality for Surgical Education in the 21st Century Arch Surg. 2000;135(7):786-792. doi:10.1001/archsurg.135.7.786 Simulated environments can be created so that skills are learned in an optimal stress-learning relationship. Preparedness for the operating room (OR) reduces stress, creating a better learning situation during real operations. Figure Legend:

5. Date of download: 5/30/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Computers and Virtual Reality for Surgical Education in the 21st Century Arch Surg. 2000;135(7):786-792. doi:10.1001/archsurg.135.7.786 Isoperformance. A plot of simulator and in-flight hours required for aviation task certification. As hours on the simulator are increased, hours of in-flight training are reduced. Figure Legend: