Advanced laparoscopic skills: Understanding the relationship between simulation-based practice and clinical performance.

•Training on the Advanced Laparoscopic Skills suturing curriculum (ALS) is feasible, but difficult.•Training on the ALS curriculum improves performance of Nissen fundoplication and closure of a gastro-jejunostomy.•Performance on ALS correlates with performance on clinical suturing.•Learning curves need to be developed to determine the length and type of training needed to achieve proficiency on ALS.