The researchers, writing in Frontiers in Virtual Reality, recruited 31 participants and trained them to proficiency in a virtual reality spacecraft piloting simulation modeled on a Mars entry, descent, and landing task. The task unfolds in three sequential subtasks. First, participants survey a topographic map to select a landing site that balances scientific value against terrain hazards. Next, they manually fly the vehicle using pitch and roll commands to follow a guidance reticle while nulling wind disturbances. Finally, they control their vertical descent speed with a hand thruster, balancing a soft touchdown against a limited fuel supply. Performance across all three subtasks is scored with an integrated skill metric that ranges from 0 to 100, anchored to definitions of poor, adequate, and excellent performance.

Training began with a proficiency phase in which participants completed up to 40 trials in VR, starting at difficulty level 8 out of a possible 25. An adaptive algorithm adjusted difficulty dynamically using a 2-up, 1-down staircase rule, where each subtask changed independently based on user performance. Proficiency was defined as two consecutive excellent trials with all subtasks at difficulty level 12. Participants were then evaluated in a fixed-base physical cockpit simulator at the University of Colorado Boulder, completing five trials of static difficulty at level 12, establishing a preflight baseline between 18 and 48 hours after the proficiency session.

The experiment then replicated a spaceflight mission scenario: a five-week gap between initial training and task execution, during which skill retention was threatened. Participants were randomly assigned to one of three retention conditions. The Weekly group returned once per week for five weeks, completing ten training trials per session in VR with the adaptive difficulty algorithm. The just-in-time group returned only once, five weeks after their baseline and 18 to 48 hours before their final evaluation, for a single ten-trial adaptive session in VR. The No Training group served as a control, representing the natural skill loss that occurs when no refresher intervention is provided. All groups returned for a postflight evaluation in the physical simulator, completing five trials of static difficulty at level 12 regardless of their performance during the intervening period.

The results were striking. Final evaluation performance was significantly affected by training condition, with a Kruskal-Wallis test yielding a p-value of 0.02. Post hoc comparisons with Holm adjustment revealed that the just-in-time group achieved a median first-trial performance of 97.4, significantly higher than the No Training group’s median of 65.0, with an adjusted p-value of 0.018. The Weekly group, with a median of 79.1, fell between the two but was not significantly different from either. When the researchers calculated a skill retention metric comparing preflight and postflight performance, the just-in-time group showed a median improvement of 11.1 points, while the No Training group showed a median loss of 23.9 points, a difference that reached statistical significance at an adjusted p-value of 0.02.

Perhaps the most unexpected finding emerged from a post hoc analysis of the Weekly group. The researchers found a negative correlation between the difficulty level achieved during weekly training and final evaluation performance, with a Spearman rank correlation of -0.71 and a p-value of 0.02. In other words, participants who trained at higher difficulty levels during the weekly sessions tended to perform worse at the final evaluation. The authors suggest this may reflect overtraining or negative training, where extended practice at difficulty levels well above the performance requirements of the evaluation may have disrupted the calibrated motor responses needed for the actual task. The just-in-time group, constrained by their single session, never reached such elevated difficulty levels, which may have inadvertently protected them from this effect.

The researchers also assessed subjective training experience through surveys of flow, motivation, preparation, and confidence administered before and after each session. None of these measures were significantly impacted by retention training condition. However, the data trended in interesting directions. The just-in-time group reported the highest overall flow, perceived skill, and perceived task importance, while the No Training group reported the lowest perceived skill and the highest perceived difficulty. Notably, the Weekly group reported the lowest confidence of success for the final evaluation, lower even than participants who had received no refresher training at all, suggesting that repeated exposure to high difficulty levels may have disrupted self-efficacy rather than building it.

The implications for training design are significant, particularly for spaceflight applications. Just-in-time training paradigms are especially enticing for long-duration exploration missions, where crews must retain mission-critical skills across gaps of six to eight months between training and execution. The communication delays of a Mars mission prevent the ground-based expert facilitation used in previous just-in-time training on the International Space Station, such as on-orbit ultrasound skill maintenance. Autonomous facilitation through adaptive difficulty algorithms offers an alternative that can be initialized at any level relative to a trainee’s current skill, without relying on human operators. The results demonstrate that VR technology can create operational training scenarios with adaptive difficulty that effectively mitigate skill decay even when conducted entirely in a virtual environment.

The study has limitations that the authors acknowledge. The sample size was small, participants were primarily recruited from college populations, and the just-in-time and weekly groups differed in both total training quantity and cadence, making it difficult to disentangle these factors. The personalized adaptive algorithm also created between-subject variability in training difficulty that is challenging to account for in the results. Future work could explore machine learning algorithms for more sophisticated identification of skill gaps, investigate retention over longer durations that better match real mission timelines, and examine how physiological deconditioning during spaceflight may interact with skill decay. Still, the core finding stands: a single adaptive just-in-time session in VR was sufficient to preserve complex piloting skills across a five-week gap, outperforming both no training and more frequent weekly practice, and offering a promising path for maintaining critical skills in high-consequence industries where trainee time is finite and the cost of forgetting is severe.

Subject of Research: Adaptive just-in-time VR training for skill retention in spacecraft piloting simulations

Article Title: Adaptive just-in-time training supports skill retention in virtual reality simulations

Article References: Putman, E., Sherman, S., Bonarrigo, L., Clark, T. K., & Hayman, A. P. A. (2026). Adaptive just-in-time training supports skill retention in virtual reality simulations. Frontiers in Virtual Reality, 7, Article 1866989. https://doi.org/10.3389/frvir.2026.1866989

Image Credits: AI Generated

DOI: 10.3389/frvir.2026.1866989

Keywords: virtual reality, just-in-time training, skill retention, adaptive difficulty, spacecraft piloting, training simulation, skill decay, human factors, aerospace training, refresher training, Adaptive, just-in-time

The original article by Jenkins and colleagues drew on a comparison that has circulated in medical education circles for years: commercial and military aviation invests enormous resources in structured, simulation-heavy, competency-based training, and aviation has achieved remarkable safety records as a result. Surgical training, by contrast, has historically depended on an apprenticeship model in which trainees learn by doing under supervision in the operating theatre. The aviation argument is straightforward in principle. Pilots are not permitted to learn critical manoeuvres for the first time with passengers on board. They progress through ground school, simulators, dual-control instruction and graduated solo experience, with every stage assessed against defined standards before advancement. Surgery, the argument goes, should aspire to the same rigor, and simulation should occupy a far larger share of the training pathway than it currently does.

Swain, Denniss and Cooper are unusually well placed to test that argument. Swain works at the Academic Department of Military Surgery and Trauma at the Royal Centre for Defence Medicine in Birmingham and is also affiliated with the Department of Learning, Informatics, Management and Ethics at the Karolinska Institutet in Stockholm, a combination that bridges operative practice and formal educational science. Denniss serves with 845 Naval Air Squadron at Royal Naval Air Station Yeovilton, giving the response direct access to the cockpit-side perspective that the original article invoked. Cooper brings experience from the Regional Occupational Health Team Bulford and the Academic Department of Military General Practice, adding a medical workforce and occupational health dimension that is often missing from training debates. Together they represent exactly the kind of cross-disciplinary triangulation that the aviation-surgery comparison demands.

The technical heart of the discussion concerns how competency is defined, measured and maintained. In naval aviation, training follows a syllabus in which each flight exercise has defined objectives, and instructors grade performance against standardized criteria. Progression is not a function of hours logged alone but of demonstrated proficiency, and critical skills are revalidated periodically. Surgical training in the United Kingdom follows a national structured competency-based pathway managed by NHS England and the four surgical Royal Colleges, with progression monitored through the Intercollegiate Surgical Curriculum Programme. The ISCP framework defines assessment and feedback mechanisms that are, on paper, not so different from aviation’s structured grading. The respondents’ letter implicitly probes the gap between that paper structure and the lived reality of training, where case availability, service pressures and rota demands can shape operative experience in ways no syllabus intends.

One of the most consequential concepts in this debate is skill decay, the gradual erosion of learned performance when a skill is not practised. Stansfield and Tai addressed this directly in BMJ Military Health, writing about surgical skill decay in what they call the contingency era, a period in which military surgeons may go long stretches between high-acuity operative cases. The problem has a precise aviation parallel: pilots who do not fly regularly must complete currency requirements and simulator refresher sessions before returning to duty, because the psychomotor and decision-making elements of flying degrade measurably with disuse. For surgeons, especially those in military or low-volume settings, the same decay dynamics apply to complex operative skills, yet the systems for detecting and correcting decay are far less formalized. Simulation offers a partial answer, allowing deliberate practice of rare and high-risk procedures without patient exposure.

The evidence base for simulation in surgical education has grown substantially over the past two decades. Aggarwal and colleagues, writing in BMJ Quality and Safety, synthesized the case for training and simulation for patient safety, arguing that simulated environments allow teams and individuals to rehearse technical and non-technical skills, from instrument handling to crisis communication, in conditions where errors carry no human cost. High-fidelity simulators can reproduce tissue handling, bleeding scenarios and equipment failures, while virtual reality platforms track metrics such as economy of motion and error rates that provide objective performance data. McGhee’s recent doctoral work on surgical technology faculty perceptions of high-fidelity simulation adds a practical layer, examining how the educators who run these programs view their value and their limitations. The respondents’ letter situates itself within this evidence landscape, and the aviation comparison sharpens the point: aviation did not adopt simulation because it was fashionable, but because decades of accident analysis showed that errors made in training carried over into operations, and that rehearsal in a safe environment prevented them.

Yet the aviation analogy has limits that a naval aviator himself would be the first to acknowledge, and Denniss’s involvement in the response gives that acknowledgment weight. Aircraft are engineered systems with standardized cockpits, quantified performance envelopes and near-complete environmental control. Patients are not. Anatomical variation, tissue quality, comorbidity and intraoperative surprise introduce variability that no simulator fully reproduces, and the surgeon’s task includes continuous intraoperative reassessment that has no clean equivalent in flying a certified airframe. Moreover, aviation’s safety gains rest not only on training but on an entire ecosystem: mandatory incident reporting, just-culture investigation, crew resource management, and checklists enforced by regulation. Surgery has imported some of these elements, most famously the surgical safety checklist, but importing training structure alone, without the surrounding safety culture, would capture only part of what makes aviation safe.

There is also a cultural dimension to how trainees learn from error, and this is where the letter’s occupational health perspective becomes relevant. Lee and colleagues, writing in Global Surgical Education, examined how individual, cultural and systems factors shape surgical residents’ experience with medical errors and their ability to learn from mistakes. Aviation’s non-punitive reporting culture, in which pilots can disclose errors without automatic career consequences, contrasts with surgical environments where error discussion can still carry stigma. A trainee who fears blame will conceal mistakes, and concealed mistakes cannot become teaching moments. Building educational systems that treat error as data rather than as failure is arguably a deeper lesson from aviation than any simulator syllabus, and it requires engagement from the occupational health and wellbeing structures that Cooper’s affiliation represents.

The timing of this exchange matters. Surgical training worldwide faces converging pressures: reduced working hours, financial constraints on theatre time, rising subspecialization, and, in military contexts, operational tempo patterns that can leave surgeons case-starved between deployments. Simulation-based and competency-based training are often proposed as solutions, but they carry costs of their own, in equipment, faculty time and curriculum redesign. The value of the aviation comparison is that it offers a tested template for allocating scarce training resources: identify the highest-risk skills, build structured rehearsal for them, assess against explicit standards, and revalidate periodically. The respondents’ letter, by bringing a surgeon’s, a flying doctor’s and a pilot’s perspectives into a single conversation, models the kind of cross-professional dialogue needed to adapt that template intelligently rather than transplant it wholesale.

What emerges from the exchange is less a verdict than an agenda. The original article by Jenkins and colleagues asked whether surgical training should look more like naval aviation training. The response from Swain, Denniss and Cooper, published as a letter in Global Surgical Education with the backing of the Association for Surgical Education’s journal, suggests the question is worth taking seriously precisely because the two professions share the same fundamental challenge: producing operators who perform rare, high-stakes procedures safely under pressure, with training systems that must be efficient, evidence-based and honest about human fallibility. As surgical education moves further into simulation, virtual reality and structured competency assessment, the aviation world’s hard-won lessons about currency, standardization and safety culture will remain a reference point, and letters like this one ensure the borrowing is done critically, by people who have sat on both sides of the cockpit and the operating table.

Subject of Research: Cross-disciplinary comparison of naval aviation training methods and surgical education, including simulation, competency assessment and skill decay

Article Title: A surgeon, a flying doctor and a pilot’s response to Jenkins’ et al. “a naval aviators’ view of surgical training”

Article References: Swain, C., Denniss, J., & Cooper, K. (2026). A surgeon, a flying doctor and a pilot’s response to Jenkins’ et al. “a naval aviators’ view of surgical training”. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 126. https://doi.org/10.1007/s44186-026-00529-z

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00529-z

Keywords: surgical education, naval aviation, simulation-based training, skill decay, competency-based training, military surgery, medical errors, patient safety, Intercollegiate Surgical Curriculum Programme, virtual reality training, Royal Navy, training reform