VR Simulators are a powerful alternative to traditional educational techniques in many domains; and in particular, in surgery. Although they offer new possibilities for learning, training and assessment, they still found difficult to be accepted and integrated into hospitals. In this paper, we explain what we consider the key issues to create successful VR simulators, and we present two methodologies: the guidelines for the simulator design and the evaluation of their validity. Research on VR surgical simulators should be interdisciplinary. It involves medicine, educational psychology, computer science, and engineering. Optimal interdisciplinary communication is difficult, and most projects in surgical simulation are strongly influenced by the engineering perspective, with little or no contributions from the others. This unbalance often leads to a premature end of the project or to simulators which are less practical for surgeons. A design methodology should be used as a guide in the process of creating VR simulators. A thorough description of the problem, the simulator’s role, and an exhaustive task analysis will lead to the identification of the requirements. For the technical implementation, decisions will be taken related to the hardware interface and the interaction that users will have with the virtual world; which will determine collision detection and response algorithms, and the behaviour of the 3D models. In addition to the technical testing, it is necessary to prove the validity of the simulator and design procedures to measure the user performance. We explain a methodology to evaluate the validity (face, content, and criterion-related validity), reliability and transfer of skills from a VR simulator to the real environment in a structured and rigorous way. Following this methodology, an evaluation experiment involving 19 orthopaedic doctors using a VR arthroscopy simulator was carried out. Results prove face and content validities, and inform about the factors and measures that are considered important for arthroscopic surgery. In order to consolidate the research results, we encourage the establishment of an intersectorial consortium with agents from the academic, healthcare and industrial sectors to ensure the long-term sustainability of research lines, additional funding, and to guarantee that simulators, once validated, can be widely available in hospitals. This paper presents a global approach including relevant guidelines and methodologies for designing and evaluating VR simulators. It can provide a solid structure for other researchers when facing those processes and contribute to the successful integration of VR simulators within the educational curriculum.