METHODS: The second year medical school class was divided into small groups who rotated between two stations. The students worked together to obtain a history, perform a physical exam, interpret EKG and rhythm strips, and administer treatments with a facilitator from the division of cardiology. One case involved a man who developed in-stent thrombosis and ventricular fibrillation. The other case involved a woman with mitral stenosis who developed atrial fibrillation with rapid ventricular response and congestive heart failure. Discussion points included mechanisms of disease and medication action, differential diagnosis of chest pain and dyspnea, the cardiovascular physical exam, and elements of professionalism involved with treating acutely ill patients and working within a multidisciplinary team. The simulations were followed by a debriefing led by a cardiology attending and/or fellow. The students scored and commented on the experience. The students took a multiple choice exam, similar to exams given in previous years. The exams and scores on the individual test questions the year of the intervention and the year prior were obtained. Two critical care physicians (BK and VK), who were not involved in development of the test, reviewed the test questions and divided them into three categories based upon how related the item content was to the simulation content - very related, moderately related, and not related.