The chief medical officer’s annual report has highlighted the need for surgeons to be trained using simulation techniques.

The report, published by Professor Sir Liam Donaldson yesterday, devotes a chapter to simulation and says that surgeons trained using simulation methods make fewer errors and carry out technically more exact procedures.

However, it says that although simulation is increasingly available, it needs to be better integrated into medical practice and better funded.

“Many doctors attending simulation courses, including those for lifesaving resuscitation, are now having to pay for them out of their own pockets and struggle to be released from service commitments to attend,” it says.

The first chief medical officer’s report was issued 150 years ago, and Sir Liam takes time to reflect on the work of the Victorian sanitary reformers and the 14 CMOs who have preceded him.

He notes that 2008 saw the publication of Lord Darzi’s latest vision for the NHS, High Quality Care for All, as well as government strategies to tackle childhood drinking, obesity, and the revalidation of doctors.

He then turns his attention to five health topics; controversally proposing that "passive drinking" should be recognised as a health threat and that a minimum price should be set for a unit of alcohol.

Sir Liam also discusses chronic pain, prostate cancer and antibiotic resistance alongside the importance of simulation. The CMO also returns to the subject of obesity, the focus of earlier annual reports.

“My concern over the growing ‘time bomb’ of obesity in this country is well known and the East Midlands is looking at the possibility of using interactive computer games to help obese children lose weight,” Sir Liam writes.

“Initial results look promising and this could prove to be one of the ways to engage overweight children in exercise.” The report describes a study in which the energy expenditure of 15 children was monitored while they were playing interactive games and sedentary games.

It found they used far more energy using the Sony EyeToy and Nintendo Wii Sports and that the consoles might overcome some of the barriers the children faced to taking more traditional forms of exercise.

The annual report also details a study carried out at Imperial College in London, which showed that surgeons trained on a simulator were twice as fast and twice as accurate as those who had not been.

It also discusses a trial in Sweden that demonstrated that junior surgeons who had not been given virtual reality training for keyhole surgery made three times as many errors and took 58% longer to carry out an operation than those who had.

Sir Liam says that “simulation-based training should be fully integrated and funded within training programmes for clinicians at all stages.” He also calls for a national centre for simulation and says that it should be adequately resourced by NHS organisations, including the National Patient Safety Agency.

Link: 150 years of the Annual Report of the Chief Medical Officer: On the state of public health 2008