Virtual reality and simulation technology promise to be key technologies in medical education. The flight simulator tech nology that has so effectively replaced live, inflight training of pilots is being reengineered for use in medical and surgi cal education. Despite the considerable enthusiasm for this concept, very little practical work has been performed to integrate simulation technology into surgical education and certification. To achieve the potential offered by medical simulation, developers of these new technologies must join with medical/surgical educators to develop meaningful simu lators and virtual learning tools. This paper reviews the cur rent paradigm in surgical education and suggests a strategy for effecting a paradigm shift that facilitates the adoption of simulation technology in surgical education.