Video-assisted thoracoscopy (VAT) is rapidly gaining application in a variety of thoracic surgical procedures. As a result, fellowship programs in thoracic surgery need to provide training in VAT techniques. Instruction should include emphasis on aspects of the open procedures, including the anatomic relationships as seen through an open thoracotomy and on cross-sectional imaging techniques. Standardization of the indications for VAT, as well as emphasis on the basic principles of visualization and operative manipulation, will serve to reinforce the advantages and limitations inherent to VAT. An initial exposure to VAT in a nonclinical context, including didactic instruction in the instrumentation and skills, review of videotapes, and animate or inanimate laboratory instruction, provides a controlled setting for learning the fundamentals. Interactive assistance with clinical VAT procedures should be encouraged once the basic principles are learned. Ultimately, guidelines and qualifications for performing VAT procedures should be incorporated into the requirements for thoracic surgical training programs.