Dr Nicola Di Lorenzo is President of the Society for Medical Innovation and Technology (SMIT). He is also the Vice Co-ordinator PhD Program on Robotics and Informatics in Surgery at the Università di Roma Tor Vergata. He is a Fellow and Member of the Steering Committee of SMIT, the Technology Committee of European Association for Endoscopic Surgery (EAES) and the International Advisory Board of Society of Laparoendoscopic Surgeons (SLS). He is also a Counselor and a member of the Technology Committee of the Italian Chapter of the American College of Surgeons (ACS) and a Counselor of the Italian Society for computer-assisted surgery (SICTeCA) amongst others. He has organised national and international meetings on new technologies in surgery and is author of more than 100 scientific papers published in national and international journals, mainly focused in the field of minimally invasive surgery and new technologies. Dr Di Lorenzo gained his medical degree at the Catholic Università di Roma Tor Vergata, school of medicine in 1984. He became board-certified in general surgery in 1989 and received his PhD in microsurgery and minimally invasive techniques in 1994. From 1994 to 2002 he undertook a post-graduate course in minimally invasive surgery and microsurgery in emergency medicine and from 1994 to 2000 undertook a residency programme of digestive surgery and surgical endoscopy, both at the Università di Roma Tor Vergata. a report by Nicola Di Lorenzo and Jenny Dankelman President, Society for Medical Innovation and Technology (SMIT) and Man-Machine Systems Group, Department of BioMechanical Engineering, Delft University of Technology Introduction In the Middle Ages, the education of surgeons (barbers) consisted of ‘learning on the job’. Currently, a large part of surgical skills are still learned in the operating room (OR) while operating on patients. The concept that gaining skills from operating on patients is not always the best way to learn for the sake of the patient and also for the sake of the surgical trainee has been effectively described. 1 Reduced working hours for trainees, increased complexity of procedures and ethical considerations force engineers and clinicians to work together and develop training methods without using patients. Recognition of the importance of errors is now becoming an essential new component in the practice of surgery and new methods and technologies are being used to identify, avoid and reduce errors. The medical community in general has ascribed errors to the ‘system’; however, during a surgical procedure, surgeons are actually the sole perpetrators of an error (the coface error) and must not shirk their accountability by blaming the error on the ‘system’. Many new methods to train surgeons have become available. This article has therefore been prepared with the accomplishments of a group of experts dedicated to training and simulation, participating in the 17th Society for Medical Innovation and Technology (SMIT) conference, being held from 28 September to 2 October 2005 in Napoli, Italy. Training Methods Education, training and the accurate assessment of skills and performance represent the most important challenge of the new century for medical schools, scientific societies, academic and clinical environments. Medical education – a field where tradition has always played a main role – is now facing new methodologies, introducing a ‘bits and bytes’ system with the use of information technology (IT) and therefore undergoing significant changes. Simulators have achieved widespread acceptance in the field of anaesthesia, intensive care, flexible endoscopy and also recently in surgery – particularly minimally invasive surgery (MIS). The fast introduction of MIS has accelerated the development of new training methods to train residents in these new technologies. A large number of training methods have been developed over the last few years. With the continuously increasing power of computers, simulators are now being offered to hospitals as a means of improving training and reducing the costs of education. Some simulators are based on phantoms (physical models, e.g. plastic structures) while others are virtual reality (VR) computer-based simulators (see Figures 1, 2 and 3). A third group is represented by the hybrid simulators, where the two components are integrated. Although phantoms may provide realism with regards to tissue behaviour, computer-based simulators will increasingly become more eligible as a training aid, particularly due to their extensive range of educational features. In some recent studies it has been shown that they improved surgeons’ performance, thus contributing to patient care. When considering simulator design, a thorough understanding of human learning, human factors, technology and the field of simulation in general is required. In the late 1980s and early 1990s – the early days of surgical simulation – developers did not generally address these well and few simulators remain today from that era. Simulators currently designed without a thorough knowledge of these areas are unlikely to be useful on a widespread basis. Design of a computerised surgical trainer requires a collaborative team. Development of the content at least requires expertise in surgical practice, education, computer-graphics (and possibly haptics) programm- ing, computer programming and simulation technology in general. All of this expertise is critical for the creation of a useful simulator prototype. Certainly, if there is a desire for the trainer to be distributed to users on a widespread basis, the Surgical Training and Simulation 1 Reference Section BUSINESS BRIEFING: GLOBAL SURGERY – FUTURE DIRECTIONS 2005 1. Gawande A, Complications: A Surgeon’s Notes on an Imperfect Science, Profile Books Ltd (2003).