Huge Cyst of the liver not frequently found. This case of massive liver cyst (left lobe) in a female patient is reported for its rarity. In this case, the patient presented with no other complaints except distention of abdomen and vague pain abdomen. To highlight diagnostic challenges and treatment options available to rural population, that is affordable and accessible.  A 57 years old female patient from nearby village, presented with distention of abdomen for 5years, which was small to start with and gradually increasing in size to attain the present size. Preoperatively, it was a huge tensely cystic swelling arising from left lobe of liver occupying whole upper abdomen. Swelling appeared to be arising from segment II and III (Couinaud system), right lobe compressed to a rim. The cyst was opened anteriorly and drained 4.8l of clear fluid. Marsupialization of the cyst was done. Though huge cystic swellings are comparatively rare, they should be considered in the pre-operative differential diagnosis of abdominal masses. They can be easily diagnosed and managed in hospitals with limited resources and are affordable to the patients also.

Background: Simulation is a way of learning skills in life like situations that are not real. Simulation based training according to many studies turned out to be effective method in skill development. In this study we have used bench top models available in our institute with simulated patients, which are accessible, and cost effective. The use of simulation in Graduate Medical Education has evolved significantly over time, particularly during the past decade. The applications of simulation include training budding surgeons in technical and non-technical skills and better prepared to face clinical situations.Methods: After 5 days of focused group discussion, 60 interns were asked to perform the two basic tasks in bench models attached to simulated patents. Skills assessed by pre-test, post-test and feedback module created for the 2 tasks. Scores was compared and analyzed, at the end of the module by summative assessment. Tasks were graded to100 point system, using rubrics and difference calculated using pair t test.Results: Mean of the skill score in pre-test 78.26±5.58, range found to be 86-73. There was significant improvement in post test score in which 86.54±4.41, range 97-66. t was found to be 5.5256, a significant improvement, and p value found in post-test 0.0002.Conclusions: Skill development with Mannequins and Standardized patients is found effective in training the interns. In addition to developing technical and non-technical skills, interns also get to communicate with simulated patients, which will make them more competent.