Interactive teaching has been shown to improve students' achievements in oral and maxillofacial undergraduate training . Due to constant and increasing development within the field of medicine and dentistry the clinician needs to develop effective tools for life-long learning. Although curriculum design does not seem to influence the attitude towards life-long learning  an interactive teaching modality provides the student with the necessary skills to independently train to solve clinical problems and thereby meet requirements of the future .
In surgery, the introduction of simulators has provided novel possibilities for a student oriented environment to develop practical skills. However, the success of a certain simulator is dependent on its introduction to a well designed curriculum and that its contribution to learning and advantages over traditional teaching has been well assessed . This in turn requires close cooperation between clinical tutors and representatives of the industry during the development and implementation of a surgery simulator. An interesting simulator is the Forsslundsystem AB Oral Surgery Simulator http://www.forsslundsystems.se/ that uses a haptic technology which enables the kinaesthetic and tactile sensation of shape, texture and friction of the operating field. Consequently the surgeon in training may receive real-time knowledge about the surgical procedure based on the modalities vision, hearing and touch .
Mandibular third molar surgery, as any kind of surgery, besides demanding practical skills also requires good clinical reasoning skills to make the correct diagnosis and for treatment planning (including ability to determine the difficulty of the planned operation and if there is a need to refer the case to a specialist or not). The use of virtual patients has been suggested to be an important teaching aid for development of such clinical reasoning . The Virtual Patient (VP) Simulation system Web-SP is an interesting tool for training these kinds of clinical reasoning skills and has been shown to give high acceptance among medical and dental students [7, 8]. It has also been shown that practicing with virtual patients in Web-SP gives a higher retention compared to traditional learning methods . Web-SP is a software which provides a common generic platform facilitating for teachers in health care sciences to create interactive patient cases without the dependence on computer specialists .
The undergraduate curriculum in oral and maxillofacial surgery for students in their final (5th) year at the Department of dental medicine, Karolinska Institutet, corresponds to three weeks full time studies. Previously the main part of this course basically contained lectures and observational teaching. Besides problems such as economical cut-down, increased number of students, reduction of teacher resources, this old curriculum faced major problems such as making the students passive. Furthermore the unaltered patient-flow caused uneven learning conditions and was very stressful for the teachers and assisting staff. A new curriculum was developed where the bulk of observational education was replaced by interactive seminars, improving the course .
A constant desire, apparent from the yearly student surveys, has been practical training in surgical removal of mandibular third molars. Due to lack of resources, this kind of clinical supervision has so far not been possible to implement. Likewise, the Swedish Dental Association has conducted several studies on the graduated dentists' perception of their dental education. A clear, dominating and recurring apprehension was that the amount of practical training in undergraduate oral and maxillofacial surgery training was insufficient .
In an attempt to further improve the curriculum, and partly meet the expectations of the students in terms of increased practical moments, simulator aided teaching has been proposed as a way to improve both clinical reasoning skills as well as practical surgery skills. The purpose of this study was to investigate undergraduate students' perception of two different simulation methods for oral and maxillofacial surgery.