A CADEMIC M EDICINE , V OL . 76, N O . 5/M AY 2001 469 R ESEARCH R EPORT ‘‘Practicing’’ Medicine without Risk: Students’ and Educators’ Responses to High-fidelity Patient Simulation James A. Gordon, MD, MPA, William M. Wilkerson, MD, David Williamson Shaffer, PhD, and Elizabeth G. Armstrong, PhD ABSTRACT Purpose. To understand the responses of medical stu- dents and educators to high-fidelity patient simulation, a new technology allowing ‘‘practice without risk.’’ Method. Pilot groups of students (n = 27) and educators (n = 33) were exposed to a simulator session, then sur- veyed with multiple-choice and open-ended questions. Open-ended comments were transcribed and coded. They were analyzed for recurring themes and tested for inter- rater agreement. An independent focus group subse- quently performed higher-level thematic analysis. Results. Overall, 85% of the students rated the session excellent and 85% of the educators rated it excellent or very good. Over 80% of both groups thought that simu- lator-based training should be required for all medical stu- dents. Analytic categories derived from written comments were: Overall Assessment (i.e., ‘‘generally good experi- ence’’); Process Descriptors (i.e., ‘‘very realistic’’); Teach- ing Utility (i.e., ‘‘broad educational tool’’); Pedagogic Ef- ficacy (i.e., ‘‘promotes critical thinking’’); and Goals for Future Use (i.e., ‘‘more practice sessions’’). Thirty percent of students and 38% of educators were impressed by the realism of the simulator, and they (37% and 25%, re- spectively) identified the ability to ‘‘practice’’ medicine as the primary advantage of simulation. The focus group rated cost as the major current disadvantage (66%). Conclusions. Students’ and educators’ responses to high-fidelity patient simulation were very positive. The ability to practice without risk must be weighed against the cost of this new technology. Acad. Med. 2001;76:469–472. Dr. Gordon is director, MEC Program in Medical Simulation, instructor in medicine, and Morgan– Zinsser Fellow in Medical Education, Harvard Med- ical School, Department of Emergency Medicine and Institute for Health Policy, Massachusetts General Hospital and Partners HealthCare System, Center for Medical Simulation and Harvard–Macy Institute, Boston. Dr. Wilkerson is clinical assistant professor, Department of Emergency Medicine, Medical Edu- cation Scholars Program, Medical Readiness Trainer Team, University of Michigan Health System, Ann Arbor, Michigan. Dr. Shaffer is lecturer on educa- tion, Technology in Education Program, Harvard Graduate School of Education, Cambridge, and (for- merly) director of education, Center for Integration of Medicine and Innovative Technology, Boston. Dr. Armstrong is director of medical education and as- sociate professor of pediatrics (Medical Education), Harvard Medical School, and director, Harvard– Macy Institute, Boston, Massachusetts. Correspondence and requests for reprints should be addressed to Dr. Gordon, Division of Emergency Medicine, Harvard Medical School, Department of Emergency Medicine, Massachusetts General Hos- pital, 55 Fruit Street, CLN 115, Boston, MA 02114-2696; e-mail:  jgordon3@partners.org. It is 3 AM at your teaching hospital in July, about ten years from now. A new third-year medical student is excited by her first day on call with the Medicine team. They just finished caring for a patient with congestive heart failure in the intensive care unit (ICU). The student had watched the senior resident and intern resuscitate the patient, then exhaustedly return to sleep. The student, still wide-awake, is amazed but confused by the myriad recent events —the exam, the endotracheal intubation, the invasive hemodynamic monitoring, the medical therapy. She cannot quite put it all together, even after reading through her ‘‘on-call’’ manual. Rounds the next morn- ing are rushed and the student is called away to a lecture. Even after reading a bit more and discussing it with her intern, she never does quite get it—would she ever get it, she wonders, before she becomes the in- tern? The next call night is not so busy, and the student recalls being told about the ‘‘practice room.’’ She punches in the se- curity code and enters to see a full-scale mannequin on a gurney connected to an IV and ICU monitor—a desktop com- puter and a projector system sit in the cor- ner. She turns on the computer, and selects ‘‘congestive heart failure.’’ A projected ho- lographic image suddenly blankets the room, transforming the space into a virtual ICU, complete with dynamic sounds, voices, and images. 1 The mannequin starts moaning, its chest heaving, and exhaust- edly complaining of shortness of breath. The student feels a fast thready pulse and glances up at the monitor. Startled, she lis- tens to the heart and lungs and hears au-