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Clinical experience has shown that surgeons need to perform a certain number of procedures to gain competency and continue performing a certain number of procedures to maintain these skills (1,2). More and more, it is becoming increasingly difficult to obtain an adequate amount of live operating, even for fully trained doctors. Reasons for this include reduced working hours, an increasingly consultant-led service, a better-educated patient body, with an increasing focus on their safety and rights. Previously junior doctors had ample opportunity to operate independently with indirect supervision from a more senior colleague; unfortunately this is becoming less common (3). Healthcare resources are becoming increasing scarce, which adversely affects the amount of theatre time that a trainee has access to (4). The European Working Time Directive led to a change in the working pattern of junior doctors in the UK with significant reduction in available hours and a greater proportion of their time spent in service provision. Furthermore, certain major operations are being replaced by less radical options such as a surgical/medical endometrial ablation replacing hysterectomy. Or alternatively, traditional surgery is being replaced by more sophisticated techniques, which experienced surgeons have to master prior to junior trainees having the opportunity to develop their skills. One example is robotic surgery and its incorporation into gynaecological minimal access surgery.

Virtual Reality Simulation: A Valuable Adjunct to Surgical Training