Lower limb amputation is the definitive surgical management of several life threatening conditions including sepsis from soft tissue and bone infections 
and vascular compromise from peripheral arterial disease or embolus. Infection and trauma are among the most common indications for lower limb amputations globally, with a particularly high indication rate in low and middle income countries.
In Sierra Leone life expectancy is 45 years and maternal and child mortality is one of the highest if all countries at 156 per 1,000 live births. Spending on the healthcare system is approximately $95 per capita (the UK is approximately $2700 per capita). There is limited postgraduate training and one of the most significant challenges for achieving safe and effective surgical care in Sierra Leone is the lack of trained surgical workforce. Across all surgical providers there are approximately 2.8 operations per week with only 400 procedures per 100,000 population. The Lancet Commission target is a minimum of 5000 per 100,000 population.
Training surgeons is expensive, time consuming and often relies on skill acquisition along a learning curve involving a high number of patient cases. 
Advances in simulation and immersive technologies may address these challenges by providing a safe and scalable training environment. The use of immersive technologies may enhance the learning of basic skills and knowledge in advance.
Innovations in the way training is delivered has explored the ‘flipped classroom’ or ‘reverse classroom’ style teaching, this is where self directed study or homework and lessons are reversed. The aim of the pre course working is to enhance the learning during the time-limited mentored sessions. It has been shown that immersive technologies enhances student engagement and knowledge acquisition.
Lower limb amputation is one of the most common procedures in Sierra Leone and will serve as an exemplar in this assessment of the use of virtual reality enhanced surgical training.