ABSTRACT: Being a competent surgeon involves many factors such as knowledge of anatomy, physiology, pathology operative theory, decision-making and communicative skills to name but a few. Manual dexterity and the actual skill required to operate has recently come under increasing scrutiny, and there is growing pressure for surgeons to demonstrate that they can operate well, and maintain this high level of performance throughout their careers. In the changing climate of surgical training, we discuss the use of various techniques of surgical simulation for teaching technical skills outside the operating theatre, and consider the advantages and disadvantages of each. Current methods of assessment that are in place both in the research setting and in practice are also presented in this article.