Surgery was traditionally learnt by repeated practice on patients. Trainee surgeons were exposed to innumerable operative cases over many years, with supervision tailored to their needs. This provided experience in coping with a wide range of operative approaches and complications, and it balanced trainees’ levels of experience with the demands of the procedure.

This process has changed radically in recent years. Minimally invasive surgical techniques have led to fast track and ambulatory surgery; service targets and reductions in working time have reduced training opportunities for young doctors; and strong ethical imperatives have made it unacceptable for novices to learn “on patients.”1 Traditional approaches are therefore no longer tenable. How then should surgeons learn their craft? In the linked randomised controlled trial (doi: 10.1136/bmj.b1802), Larsen and colleagues assess the effect of virtual reality training on surgical performance in laparoscopic surgery.2

Simulation offers obvious benefits, especially in mastering counterintuitive techniques such as minimal access surgery. Sophisticated virtual reality simulators can provide anatomically realistic recreations of many operations, with inbuilt metrics …