A great article was just released from the SF VAMC on Resident education utilizing simulation in high risk clinical arenas. The type of scenarios and teams used for this are not easy to manage and the group should be congratulated for pulling this together. The best simulation comes from pulling together teams that the residents would experience in real life situations and this group accomplished that goal. As the authors profess, this is no easy task! A vast majority of residents expressed that the difference between a good and excellent resident was his ability to lead a team (75%!!!!). I believe I am reading this correctly and to me what was interesting was the self awareness expressed by the PGY1 and 2 residents regarding the use in the training in improving their own personal teamwork and communication skills. Both of these measures were rated -by the residents- as close to 50%!!!. I was not personally at this training so I cannot dispute nor agree with this, but I simply cannot imagine that half of these PGY1 and 2 residents did NOT gain proficiency in these two areas. This study essentially proves this was not true!! As noted by observational data, "residents demonstrated significant improvement in leadership skills over the course of the academic year" and an improvement of situational awareness. As my experience (personal and observational) tells me, we can all learn how to be a better team leader and communicator and at the PGY 1 and 2 level the potential to learn and grow is astronomical. So perhaps one of the limitations of our current training methodologies is that (as humans) we simply cannot accept our shortfalls prior to training and the fact that we actually are becoming better leaders during this training. There are many studies that confirm our deniability when it comes to our character deficits. I applaud everyone out there who persist in moving this training forwards in spite of resistance as the data clearly shows it improves our abilities to care for patients.