Rapid advances in technology and the public and institutional demand to improve quality and safety have led to an increased use of simulation technology in medicine.

What is simulation? It refers to the process of imitating a course of events and ranges from the use of standardised patient encounters to robot-manikins to computerised virtual environments. A simulator is the apparatus that reproduces a procedure that must be learnt and that incorporates assessment measures that allow progress and learning to be measured. In the medical context virtual reality (VR) simulation replaces an actual clinical episode with a simulated experience in a computer-generated environment, permitting doctors to acquire core skills in a safe environment without jeopardising patient safety.1

A cardiopulmonary patient simulator like “Harvey” was first presented at the American Heart Association Scientific programme in 1968. Medical students who used Harvey during their cardiology elective acquired more cognitive information and were better skilled in bedside cardiac examinations than their colleagues who were trained traditionally.2 In 1999 the American College of Cardiology’s Task Force on Teaching recommended Harvey for day-to-day training in bedside skills.3

Technical skills may be enhanced by using bench-top models or high-fidelity tissue-based simulators, but most research in VR simulation has focused on minimally invasive techniques such as laparoscopic and endovascular interventions.

Training opportunities are restricted owing to the increased use of non-invasive imaging techniques and the diminishing working week of trainees. High-risk and complex endovascular interventions such as carotid artery stenting (CAS) and the primary concern for patients’ safety resulted in 2004 in the report of the Food and Drug Administration that simulation may be beneficial as part of a training package before allowing doctors to perform …