The point is that much of what we traditionally take for granted in medicine is a distortion or a recreation of physical reality in a new form that is more palatable and intelligible; in other words, it is a simulation of reality. Heart sounds heard through a stethoscope have been used as surrogates for human heart valve function since the days of the French physician René Laënnec in the 17th century. A chest radiograph, like a photograph, is an image of x-rays passing through the human chest, whereas an ECG is a simplified representation of the electrical activity of the heart. In this new and exciting world of medical simulation, learning experiences will be interactive and involve multiple media. Health care likely will follow the aviation model where learning to fly and maintenance of established flying skills are experienced, updated, and tested in a flight simulator. Preface to the full flight simulator experience is a vast array of preliminary experiences within a zero-risk training environment; often, training on component tasks such that subsequent amalgamation may occur. Similarly, whether training for procedures, communications (the root cause of most preventable deaths), or cultural proficiency, various tools will be selectively used and integrated for optimal impact for greatest value.