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Background: Participation in simulation can improve future performance, but it is unclear if observation of simulation scenarios can produce an equivalent benefit., Methods: First-year surgical residents were exposed to various simulation scenarios in groups of 4 or 5, either through active participation or passive observation. Residents were individually assessed on 3 of the scenarios. Scores were categorized based on resident level of exposure to the scenario and analyzed using a multivariate analysis., Results: 32 residents were enrolled and 28 underwent testing. Previous exposure to the scenario as a participant or observer led to improved performance on medical management and overall performance compared to those who had not been exposed (p < 0.02). However, active participation did not improve performance relative to passive observation (p > 0.1). Previous exposure did not improve communication aspects of the scenarios., Conclusion: Analyses confirmed the advantage of simulation-based training, but additionally suggest that the benefits for similar in both active participants and passive observers. This supports the idea of group based simulation training which can be more cost and time efficient., Competing Interests: Declaration of competing interest The authors deny any conflict of interests., (Copyright © 2020 Elsevier Inc. All rights reserved.)