Training surgical skills in virtual reality (VR) trainers holds promise for successful skill acquisition. VR can simulate complex procedures, present varied physiology, and provide detailed performance feedback. However, VR trainers have not gained wide acceptance as a dominant training modality. Simple mechanical "box trainers" are still used more widely for training basic skills, with the possibility of training more complex skills using more sophisticated physical models of physiology. Combining both VR and mechanical box trainers in a unified curriculum can capitalize on the strengths of VR and the strengths of simple mechanical trainers in an integrated program of practice and feedback. Diagnostics from performance on VR trainers can be used to develop a personalized curriculum for practice on box trainers, with detailed feedback provided through intermittent VR sessions. This integrated approach can increase resource utilization, improve training efficiency, and may lead to better transfer of training to the patient-care environment.