The world has evolved and we are now living in the age of nuclear weapons and silicon chips. This is also the age of computers and information technology, commonly referred to as the 'e-age'. It is ironic that man made machines and computers, and now these gadgets are used to clone and make a 'brand new' man or robot that can substitute humans in performing repetitive tasks or work that demand a high degree of precision! Advances in IT have made a tremendous impact on medical education and training, resulting in continuous changes in our field.

There is an ever-increasing dependence on computers in all spheres of life and we, as surgeons and educators, are expected to learn to use the computer for everyday office tasks (e.g. writing documents, collecting data and preparing spreadsheets, and putting a presentation together) just like a toddler is expected to learn the alphabet. The Internet has become part of existence. We feel suffocated and cut off from the world when we are denied access to our email even just for a day.

Looking at the bright side, we have all gained immensely from technological advancement. The Internet provides easy access to a whole lot of medical literature that was either unavailable or expensive earlier. We now have access to leading journals online, many of which are free. In addition, the Internet's search engines grant its users access to an immense amount of information on any subject under the sun. Data access is no more an issue; the world has become smaller.

A number of web-based learning programmes and websites are now at both students' and teachers' disposal. Medical students can actually attend an online tutorial through the IVLE by reading the steps of surgical procedure and viewing digital video recordings of how various operative procedures are performed by pioneers and experts in every field. Online forums facilitate class discussion and debate on different clinical practices and difficult clinical cases.

The first computer invented by Charles Babbage at the turn of the 19th century was a gigantic machine that needed an entire room to accommodate it. However, with the invention of the silicon chip and the microchip, that monster has become extinct. Now, we not only have light, sleek and portable laptops, but also a variety of fanciful Personal Digital Assistants (PDAs) to choose from. The PDA is gaining popularity because of its functionality and size. Healthcare professionals can use the PDA to search drug databases, understand more about disease management protocol and calculate different medical formulae at the press of a button. Also, many standard medical textbooks are now available in PDA format and these serve as ready references.

Virtual and simulated training has increasingly become integral to many educational programmes. Medicine, especially surgery, has adapted the technology used in virtual flight simulators to create virtual models that allow a trainee surgeon to get a feel of endoscopic surgery. In addition to working on depth perception on a two dimensional visual display and enhancing hand-eye coordination, these simulators endeavour to take a trainee surgeon through an operation step-by-step, allowing him to familiarise himself with anatomical planes and tissues. The simulators are now available to train our postgraduate doctors in upper and lower gastrointestinal endoscopy, urological percutaneous procedures, angio-vascular stenting, gynaecological surgery, basic to advanced endolaparoscopic tasks, cholecystectomy, ventral hernia repair as well as gastric bypass for obese patients with different degrees of difficulty. With the latest models offering haptic and tactile perception, it renders the continuous development of such educational tools more and more important in all training programmes. Training surgeons with simulators avoids exposing patients to unnecessary risks when trainee surgeons practise on them. Virtual and simulated training comes with a host of obvious benefits. Studies have validated that surgeons trained with such training methods showed improvements in medical and surgical skills.

Today, medical training programmes are different from the past where didactic lectures were the main mode of instruction. Now, a modern, integrated medical training programme involves dry laboratory and live-tissues training, as well as practising on surgical simulator and discussing surgical videos. Mentoring and proctoring activities can be arranged using communication technology-a science that in the medical field due to various problems and difficulties (e.g. high cost, needs of Integrated Services Digital Network [ISDN] lines, broadcasting equipment, Compression-Decompression devices [CODEC]), has never been widely accepted and utilised. The conventional telemedicine is utilised to beam radiology (Computed Tomography-scan [CTscan], Magnetic Resonance Imaging [MRI]) or vital signs (blood pressure, electrocardiogram [ECG]) but with some limits as still pictures and small size images (in cases of live images) caused by CODEC affect the quality of the images and amplify the delay between audio and video. The existing technology utilises bandwidth of 128 kilobits per ISDN line and usually three lines are utilised with a total of 384 kilobits. Even with the availability of Asymmetric Digital Subscriber Line (ADSL) technology for broadcasting, we still need to compress the images for transmission. The key factors for a successful telemedicine/telesurgery are: high-quality images, high-speed connectivity, little time-delay and multichannel broadband. We started a project utilising the high speed broadband technology of 30-35 megabits per second (Mbps) to broadcast live-telemedicine/ telesurgery. This technology, with a high frame rate video signal, allows users to utilise non-compressed images for broadcasting.

In the surgical field, robotic surgery utilising the Da Vinci® system (see http://www.intuitivesurgical. com/index.aspx) has gained popularity worldwide and promises significant benefits for patients especially in such fields as cardiovascular surgery and urology. With the addition of 3-D vision and seven degrees of freedom, tasks like suturing and micromanipulation are simpler than with conventional endolaparoscopic surgery, where 2-D vision and restricted movements (only three degrees of freedom) must be compensated by a surgeon's dexterity and skill. Robotics has hit the industry in a big way. Though its use is limited to a few surgical fields as of today, it has opened a Pandora's Box. Its applications will definitely increase with time, accommodating a wider range of dexterity and technique. Research is underway to allow unmanned state-of-the-art vehicles to pick up wounded soldiers from combat fields, scan them from head to toe, start primary resuscitation in a matter of minutes, and subsequently, fly them out in unmanned helicopters to the nearest medical base. The implications are enormous.

We have developed a breed of machines that may soon outlive and overpower the maters who created them. The science fiction movies depicting robots replacing mankind may soon become a reality.