'See one, practise on a simulator, do one' - the mantra of the modern surgeon

Minimally invasive techniques are now well established in paediatric surgery. Training has traditionally been based on an apprenticeship model, as for open surgery. More recently the constraints of litigation, finance and restriction of doctors' working hours have led to a need to rethink this training. Simulation to learn and improve skills is by no means a new concept, but has been suggested as a way to address the above issues because it provides an ideal platform for acquiring the necessary skills for modern laparoscopic surgery. This paper explores some of the current issues of learning minimally invasive surgical skills in a simulated environment, and suggests that such simulation should not be seen in isolation but as a part of a wider and encompassing curriculum of learning for the 21st-century surgeon.