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J R Soc Med. 2007 February; 100(2): 68.
PMCID: PMC1790979

Training tomorrow's surgeons

Jackson and Gibbin1 point out that one of the fundamental problems faced by today's surgical trainees is decreased operative exposure. This is a result of a combination of reduced working hours due to the European Working Time Directive, and shortened surgical training. In addition, there has been much debate over the medico-legal and ethical issues regarding consent, where trainees practice on real patients under the supervision of surgical tutors.2,3 The traditional assessment of direct observation of trainee performance is often influenced by subjectivity, since different trainers have different expectations, and the use of a logbook only demonstrates individual trainee operative exposure and not competency. The accuracy of these logbooks are also often questionable as they rely heavily on self-assessment, and hence tend to lack reliability and validity.4 We therefore agree with the authors that we have much to learn from the aviation industry, especially regarding the use of virtual reality simulators.

Virtual reality simulators allow automated objective measurements and assessment of surgical skills, which were not previously possible. It also allows new surgical trainees to be trained in their own time without endangering patient lives, and for some simulators, the predictive validity of skills transfer to real operations has been proven.

Although this type of training is still in its infancy, we can anticipate that virtual reality simulators will be a great asset to the surgical training curriculum, both as means of training, as well as an assessment tool.


Competing interests None declared.


1. Jackson CR, Gibbin KP. ‘Per ardua...’ Training tomorrow's surgeons using inter alia lessons from aviation. J R Soc Med 2006;99: 554-8 [PMC free article] [PubMed]
2. O'Toole RV. Measuring and developing suturing technique with a virtual reality surgical simulator. J Am Coll Surg 1999;189: 114. [PubMed]
3. Verdaasdonk E. Validation of a new basic virtual reality simulator for training of basic endoscopic skills. Surg Endosc 2006;20: 511-8 [PubMed]
4. Moorthy K, Munz Y, Sarker SK, Darzi A. Objective assessment of technical skills in surgery. BMJ 2003;327: 1032-7 [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press