In this issue of CHEST (see page 854), the “Patient Safety Forum” section presents a provocative essay from two national leaders in British health-care innovation and change.1 They ask a simple but insightful question: Why is medical simulation being used only sporadically within their health-care systems as a safety and quality improvement tool, when there is overwhelming scientific evidence documenting the value of simulation in high-risk professions, including that of clinical medicine? Rarely do face value, conceptual agreement, and evolving scientific evidence provide as strong a case as that for simulation-based training in medicine. Dr Rajesh Aggarwal serves as clinical scientist and specialist registrar in surgery at Imperial College London. His colleague and coauthor, Professor the Lord Darzi of Denham PC, KBE, is Hamlyn Chair of Surgery at Imperial College London. He is a past health minister of the United Kingdom. Aggarwal and Darzi1 argue that if, as a society, we truly want the best health care, including the safest care (ie, ameliorating adverse events), then proactive use of intelligently selected and integrated medical simulation is an essential component. Simulation should be consistently used to select, train, credential, and revalidate health-care practitioners at all levels of training, crossing disciplines and professions. In their view, drivers for such fundamental system changes must come both from within and outside the profession. Is such a view realistic and attainable? Is this, like some distant Oz, a dream of idyllic fantasy, or is it indeed a realistic opportunity that can facilitate real, pragmatic, affordable, improved value in delivered care globally?