22 residency students due to perform an endoscopic carpal tunnel release (ECTR) were randomized to prepare for surgery by either using an ECTR simulator or through independent preparation without a simulator. The purpose of this study was to determine the efficacy of the simulator as an adjunct to surgical practice in order to improve procedural proficiency and surgical knowledge. Pre- and post-preparation tests were conducted prior to, and following the preparatory period and operative performance was evaluated perioperatively and postoperatively. The results of this trial indicated that residents in the simulation group had significantly greater operative performance and post-preparation test scores, reflected even in inexperienced residents, when compared to the non-simulation group.