With Irish companies becoming global players in information technology (IT) we may have become accustomed to world technology firsts in this country. But one such event last June caught the eye - the launch of the world's first online surgical training programme by the RCSI.

BeST, or electronic Basic Surgical Training, is a virtual university enabling trainee surgeons to access a flexible training programme on the Internet no matter where they are in the world, 24 hours a day, 365 days a year. The development represents a multi-million pound investment by the RCSI, which is responsible for the surgical training of doctors in Ireland. The technology was developed in conjunction with Intuition, an e-learning specialist company.

"This was the brainchild of the postgraduate surgical team under the direction of Oscar Traynor," says prof Stanley Monkhouse. "The BeST programme will provide a great opportunity for trainees to avail more of distance education."

Development work on the programme began in 1999 when the college had discussions with Dermot Desmond and senior management of Intuition. These discussions led to an agreement to develop an online programme for basic surgical training.

The main reasons behind this decision was to provide the college's services to trainees in hospitals outside of larger urban areas. There was an identified need for a common and consistent course leading to the Associate Fellowship/Membership in Surgery Examination.

An editorial board chaired by Prof Frank Keane was established to confirm that the course content was accurate, complete, appropriate and that it reflected best practice in surgery. The project started in August 1999 under Oscar Traynor's direction with over 100 surgeons contributing.

The online course is based on the agreed inter-collegiate syllabus for basic surgical trainees and consists of 18 modules. Trainees log on through the Internet and, having paid for the course, have their own home page available to them. From there, they can access the learning programmes, contact other trainees, or contact tutors for advice.

The individual trainee home page is a very important aspect of the programme as it effectively customises the course to each trainee's needs. The page shows them which tutorials they have studied, which ones they have revised, which tests they have completed and there is a record of their test performance. From the home page the trainee is just two mouse clicks away from any specific tutorial or test which are all very easy to find on the very well designed site.

The programme is based on a learning methodology developed by Intuition known as OC2E. This stands for orientate, communicate, connect and evaluate and these four key instructional design elements form the framework for each of the 18 modules in the course.

WHILE using the very latest and best in multimedia technology, the course is still simple to access and use. It requires a standard PC and works with all of the standard Web browsers. It also uses the most popular animation software. This ensures that there are no technical barriers to getting online, getting active and getting focused on learning.

The programme also creates a virtual classroom. Trainees are encouraged to engage in online discussion and debate with other trainees. Problems can be shared, issues discussed and case studies argued over in the community area.

BeST also encourages trainees to engage with their tutor by asking questions online, raising areas of confusion and seeking qualified advice. BeST trainees also gain access to the wider RCSI facilities - they can visit the college library online and get access to the wide range of useful materials available from that source.

"We see this as a model for the way education is going," says prof Kevin O'Malley, registrar of the RCSI. "We are looking at projects with other partners in medical education using this model. BeST provides a knowledge base that supports clinical practice. This will be a prototype for similar programmes in a large number of specialities."

Already the college is planning to provide the education element of the anaesthesia course in this way. It is hoped to do this in conjunction with the College of Anaesthetics.

While the study of medicine may never go totally online, this ground-breaking course points the way to the future for the training of surgeons not just in Ireland but across the world.