Surgical training is currently in a state of flux, with dramatic changes in the way it is structured and delivered. The greatest challenges to surgical training have come from the advent of minimally invasive surgery in the 1990’s and more recently the reduction in a doctors working hours. This has led to a significant decrease in training opportunities that are available to the surgical trainee. Simulation has been heralded as an effective adjunct to surgical training whilst ensuring high standards of patient safety. This thesis aims to investigate the factors influencing current surgical training methods and whether simulation can be used to improve the effectiveness of surgical training in a cost efficient manner. The first part of this thesis investigates the impact that the reduction in working hours has had on surgical training, and whether the use of simulation can alleviate this. The reduction in working hours for doctors has led to a significant reduction in training opportunities. However, laboratory based simulation training can improve technical skills, provided it is used as part of a proficiency based technical skills curriculum. The second part of this thesis investigates the impact that innovations in surgery have had on surgical training, and whether simulator technology can advance at a similar rate. The introduction of single incision laparoscopic surgery provides further challenges for the surgical trainee, and it is clear that a novice laparoscopic surgeon needs further technical skills curriculum based training before entering the operating room. In addition, advancement in simulator technology now allows senior surgeons to learn advanced techniques in the skills laboratory. The final part of this thesis aims to assess the current costs of surgical training in the operating room, and whether simulation can improve operating room efficiency such that cost savings can be made. One of the main criticisms of simulation training is that it is expensive. However, the evidence in this thesis demonstrates that traditional training is also very expensive; and with prior training on simulation, operating times can be significantly reduced, providing sufficient cost savings that make simulation cost efficient. Simulation works. This is clear from the literature and from evidence provided by this thesis. Although simulation alone is not sufficient to train surgeons to operating room proficiency, it can provide a useful adjunct to surgical training. It allows trainees to train in the safety of skills laboratory, and shorten the learning curve in the operating room which in turn improves patient safety. If appropriate simulators are selected and used correctly, it can provide benefits to the healthcare system by reducing costs through an improvement in operating room efficiency.