In parallel with the introduction of working time regulations that have led to changes in working patterns, surgical trainees are taking longer to achieve operative competencies and logging fewer surgical cases. 1–3 The existing style of surgical training appears to provide insufficient operative exposure in limited working hours.

Background: The need for simulation in minimally invasive surgery (MIS) has been established. Uptake of simulator training remains poor however. This study quantifies the global availability of simulation equipment, how it is currently used and clinicians' aspirations for the future, including the emerging phenomenon of pre-operative rehearsal/warm-up. Methods: An online survey was distributed to 1314 operating clinicians via a global professional media network. Results: Two hundred ninety-two responses were received from 145 different cities in 63 countries. Responders were drawn from a range of surgical specialties. Only 34% reported access to a simulator during working hours, falling to 20% outside working hours. Forty-six percent had not used a simulator at all in the last 12 months, and only 19% had used it for more than 6 h in the preceding year. Seventy-nine percent supported the idea that a trainee should demonstrate basic competency on a simulator before operating on patients. Three-quarters think that there is a role for take-home MIS simulators; 86% support the use of MIS simulators for pre-operative warm-up, but only 26% currently do this. Conclusion: Worldwide there is great enthusiasm for the integration of simulators into training and surgical practice. Suitable simulation equipment is lacking however. There is strong support for the concept of take-home simulation to address this problem.

The traditional, time-intensive apprenticeship model of surgical skill acquisition has become impracticable in the current era of working hour restrictions that limit the total hours available for surgical training.1–3 Trainees feel 'hands on' operative exposure has been reduced, having an impact on training as well as patient safety.4 while working hour restrictions persist, simply increasing the length of surgical training will not adequately overcome reduced exposure to operative training. Improving quality and efficiency of training must therefore utilise learning outside the operating theatre; simulation training could form part of this.

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The traditional, time intensive apprenticeship model of surgical skill acquisition has become impracticable in the current era of working hour restrictions limiting the total hours available for surgical training. Trainees feel 'hands on' operative exposure has reduced, impacting on training as well as patient safety. While working hour restrictions persist, simply increasing the length of surgical training will not adequately overcome reduced exposure to operative training. Improving quality and efficiency of training must therefore utilise learning outside the operating theatre; simulation training could form part of this.