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Recent media attention on high-profile cases of flawed surgical practice has led to increasing awareness amongst the public and surgical profession of the need for quality control in surgery. Vascular surgery remains a highly technical and unforgiving specialty. These factors together with recent reductions in trainees' work hours have driven surgical educators to develop new methods ofenhancing surgical training and assessing technical perfonnance. Simulation using synthetic models allows for augmentation of training and assessing surgical technique whilst avoiding ethical concerns with animal models and storage and licensing problems associated with cadavers. Hypothesis 1. Vascular surgical training can be enhanced by training on synthetic simulators. 2. Technical skill in vascular surgery can be assessed in a standardised, objective and robust manner with these simulators in an examination setting. Results Three methods were utilised initially, to assess surgical skill: qualitative assessment using rating scales for generic surgical technique (p<O.OOI); quantitative motion analysis using electromagnetic sensors to quantify economy of movement (p<O.OOl); assessment of the surgical end-product (p<O.OOl). Surgical assessment was enhanced by scoring for procedural as well as generic skill and this technique could differentiate between a newly appointed and experienced consultant (p<O.05). The aforementioned techniques were applied before and after workshop training and significant improvements were seen in the generic (p<0.01) as well as procedural skill (p<O.Ol). The end-product improved (p<O.OOl) and operative time was reduced (p<O.05). In an examination setting the models used differentiated between newly appointed and senior consultants (p<O.O 1) and offered a high level of inter-observer reliability (0)0.8). Technical skill did not correlate with the results from an oral examination or log-book training. Conclusion Vascular surgical training can be effectively supplemented by training on simulators. Simulation with the assessment criteria described can be used in a valid and robust examination of technical skill.

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