--- title: "Training simulators · Simulations · Simulation Hypothesis" url: https://simulation-hypothesis.com/simulations/training description: "Simulations with a person in the loop: cockpits, operating theatres, control rooms and bridges. Part of a taxonomy of the simulations people actually run." license: https://creativecommons.org/licenses/by/4.0/ credit: "Ross Allan Dahl, Simulation Hypothesis (simulation-hypothesis.com)" --- [Simulations](https://simulation-hypothesis.com/simulations)domain 14 of 18 # Training simulators Simulations with a person in the loop: cockpits, operating theatres, control rooms and bridges. These are simulations with a human operator in the loop. The point isn't to predict the world. It's practice: letting people rehearse rare, costly and dangerous situations before they meet them for real. ## Vehicles ### Full-flight simulators A replica cockpit on a motion platform with the aircraft’s flight model, systems and failures, good enough that pilots qualify on new types in them. Question it answers: Can the crew handle an engine failure on take-off? Leaves out: Motion platforms approximate acceleration; sustained acceleration cannot be reproduced. Runs on: about 10^13 FLOPS rough a simulator's dedicated computer, real time Since: 1929 Edwin Link's pneumatic pilot trainer In the simulations tree: [Link Trainer](https://simulation-hypothesis.com/trees/simulations?n=w-linktrainer) [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)floor: Bodies ### Driving and rail simulators A car or train cab with a projected world, used for research and teaching. Question it answers: How do fatigue, distraction or a new display change how people drive? Leaves out: Drivers know the environment is not real, so risk-taking does not fully match that on the road. Runs on: about 10^13 FLOPS rough a dedicated simulator computer, real time Since: 1970 by 1970, early university driving simulators for road safety research [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)floor: Bodies ### Ship bridge simulators A full ship’s bridge with realistic handling, weather and harbour traffic. Question it answers: Can the pilot bring this ship into a narrow harbour in a crosswind? Leaves out: Rare mechanical failures and true sea conditions are hard to fully replicate. Runs on: about 10^13 FLOPS rough a dedicated simulator computer, real time Since: 1972 by 1972, early full-mission ship bridge simulators for officer training [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)floor: Bodies ### Spaceflight and mission control Spacecraft and mission-control simulators running every phase of a flight, with failures injected on purpose. Question it answers: Can the crew and the ground team handle what goes wrong? Leaves out: Only failures the designers expected are injected. Real missions throw up ones they didn't. Runs on: about 10^13 FLOPS rough mission-control simulator computers, real time Since: 1959 early NASA simulators trained the first astronauts and ground teams [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)floor: Bodies ### Heavy equipment simulators Cranes, excavators and mining trucks with realistic controls and loads, for training operators away from a real site. Question it answers: Can the operator handle this load or this ground safely? Leaves out: Real ground conditions and machine wear are harder to replicate than the model assumes. Runs on: about 10^12 FLOPS rough the simulator's own computer, real time Since: 1990 by 1990, early crane and mining equipment simulators for operator training [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)floor: Bodies ### Diving and submersible simulators Underwater conditions, buoyancy and vehicle handling for divers and crewed submersible pilots. Question it answers: Can the diver or pilot handle an emergency at depth? Leaves out: Real water pressure and cold on the body are things a simulator on land cannot recreate. Runs on: about 10^12 FLOPS rough the simulator's own computer, real time Since: 1978 by 1978, early submersible pilot training simulators [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Differential equations](https://simulation-hypothesis.com/simulations/methods#m-equations)floor: Bodies ## Medicine ### Surgical simulators Virtual tissue and instruments with force feedback, for practising procedures. Question it answers: Is this trainee ready to operate on a real patient? Leaves out: Virtual tissue does not bleed, tear or smell as the real thing does. Runs on: about 10^12 FLOPS rough a desktop with haptic hardware, real time Since: 1993 by 1993, early virtual-reality simulators for laparoscopic surgery [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Continuum fields](https://simulation-hypothesis.com/simulations/methods#m-continuum)floor: Fields ### Patient simulators Manikins that breathe, bleed, talk and respond to drugs, for emergency and team training. Question it answers: Does the team recognise the problem and act in time? Leaves out: Physiology is scripted to the scenario; unscripted complications do not emerge on their own. Runs on: about 10^10 FLOPS rough an embedded computer inside the manikin, real time Since: 1969 the first anaesthesia training manikin, built in Los Angeles [Physical analogue](https://simulation-hypothesis.com/simulations/methods#m-analogue)[Differential equations](https://simulation-hypothesis.com/simulations/methods#m-equations)floor: Bodies ### Dental simulators Virtual teeth and gums with force feedback, for practising drilling, fillings and extractions. Question it answers: Is this trainee's hand steady and careful enough for a real patient's mouth? Leaves out: Virtual tooth and gum tissue still feels more uniform than a real patient's mouth. Runs on: about 10^11 FLOPS rough a dental school workstation, real time Since: 1997 by 1997, early haptic dental training simulators [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Continuum fields](https://simulation-hypothesis.com/simulations/methods#m-continuum)floor: Fields ### Childbirth simulators A birthing manikin with a model baby, for practising normal delivery and rare emergencies like a stuck shoulder. Question it answers: Does the team recognise and manage a birth emergency quickly enough? Leaves out: The manikin's fixed set of complications does not cover every real birth emergency. Runs on: about 10^9 FLOPS rough an embedded controller inside the manikin, real time Since: 1996 by 1996, early computerised birthing manikins for obstetric training [Physical analogue](https://simulation-hypothesis.com/simulations/methods#m-analogue)[Differential equations](https://simulation-hypothesis.com/simulations/methods#m-equations)floor: Bodies ### Anaesthesia simulators A virtual patient's breathing, heart and drug response, controlled by a trainee giving anaesthetic drugs. Question it answers: Does the trainee dose correctly and catch a complication before it becomes dangerous? Leaves out: The model's drug responses are typical ones; real patients react more variably. Runs on: about 10^11 FLOPS rough a training centre desktop, real time Since: 1967 Sim One, an early anaesthesia training manikin with simulated physiology [Differential equations](https://simulation-hypothesis.com/simulations/methods#m-equations)[Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)floor: Bodies ### Paramedic and mass-casualty triage training Simulated casualties with different injuries, used to practise sorting patients by urgency under time pressure. Question it answers: Does the trainee sort patients correctly when there are more casualties than hands to help? Leaves out: Actors and manikins cannot fully convey the disorder of a real mass-casualty scene. Runs on: about 10^10 FLOPS rough a training exercise's basic equipment, little computing Since: 1988 by 1988, early computer-assisted mass-casualty triage exercises [Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)[Agent-based](https://simulation-hypothesis.com/simulations/methods#m-agent-based)floor: Bodies ### Virtual human patients Animated characters respond to a trainee's questions with scripted or generated dialogue to practise clinical skills. Question it answers: How well can a trainee interview a patient who is not real? Leaves out: Dialogue range is limited, and nonverbal cues are shallow. Runs on: about 10^9 FLOPS rough Real-time rendering and dialogue Since: 2007 Virtual patients for clinical therapist skills training (2007) [source](https://doi.org/10.1007/978-3-540-74997-4%5F19) [Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)[Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)floor: Bodies ### Agent hospitals A simulated hospital in which language-model doctors, nurses and patients carry out the care process and improve with experience. Question it answers: Can agents practise treatment in a virtual hospital and improve? Leaves out: Patients and diseases are generated, so realism of outcomes is unproven. Runs on: about 10^14 FLOPS rough Many model calls per simulated case Since: 2024 Agent Hospital: a simulacrum of hospital with evolvable medical agents (2024) [source](https://arxiv.org/abs/2405.02957) [Agent-based](https://simulation-hypothesis.com/simulations/methods#m-agent-based)[Learned emulators](https://simulation-hypothesis.com/simulations/methods#m-learned)floor: Rules ### Catheter and endovascular simulators A haptic device mimics a catheter and a virtual X-ray image of the vessels so trainees can practise cardiac or vascular procedures. Question it answers: Can a trainee thread the catheter without damaging the vessel? Leaves out: The feel of tissue is approximate and unusual anatomy is limited. Runs on: about 10^10 FLOPS rough real-time physics and haptics on a workstation. Since: 2000 Dawson and colleagues, designing a computer-based simulator for interventional cardiology training. [source](https://doi.org/10.1002/1522-726x%28200012%2951:4<522::aid-ccd30>3.0.co;2-7) [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Continuum fields](https://simulation-hypothesis.com/simulations/methods#m-continuum)floor: Bodies ### Structured clinical examinations Trainees move through a series of stations with trained actors playing patients and are scored against a checklist. Question it answers: Can this trainee take a history and examine a patient to the standard? Leaves out: An actor cannot produce real physical signs such as a heart murmur or an enlarged liver. Runs on: no computer. no computation, a human role-play exercise. Since: 1975 Harden and colleagues, assessment of clinical competence using an objective structured examination. [source](https://doi.org/10.1136/bmj.1.5955.447) [Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)floor: Rules ### Ultrasound training simulators A dummy body and a probe, with a computer showing the ultrasound image for that position, drawn from stored scans of real patients. Question it answers: Can a trainee learn to find and read ultrasound views without a patient? Leaves out: A limited library of stored cases cannot show the variety of real bodies or the feel of pressing the probe. Runs on: about 10^9 FLOPS rough real time on a workstation. Since: 2004 Maul and colleagues' experience with SonoTrainer and comparative review of other ultrasound simulators. [source](https://doi.org/10.1002/uog.1119) [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)floor: Bodies ### Robotic surgery simulators A virtual copy of a surgical robot's console in which trainees practise moving instruments, cutting and suturing in simulated tissue, with scores for skill. Question it answers: Is a surgeon safe to operate with the robot, as shown by practice in virtual tissue? Leaves out: Virtual tissue is simpler than the real thing, so bleeding and complications are not well trained. Runs on: about 10^9 FLOPS rough real time on a workstation. Since: 2009 Kenney and colleagues' face, content and construct validity study of the dV-Trainer virtual reality robotic simulator. [source](https://doi.org/10.1016/j.urology.2008.12.044) [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)[Continuum fields](https://simulation-hypothesis.com/simulations/methods#m-continuum)floor: Bodies ### Eye surgery simulators A model eye viewed through a real microscope with virtual instruments inside it, to practise steps such as removing a cataract, with feedback on errors. Question it answers: Can a trainee learn delicate eye surgery before touching a patient? Leaves out: The eye's tissue is modelled coarsely, so rare complications are not rehearsed. Runs on: about 10^9 FLOPS rough real time on a workstation. Since: 2009 Feudner and colleagues' randomised trial showing virtual reality training improves wet-lab performance of capsulorhexis. [source](https://doi.org/10.1007/s00417-008-1029-7) [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)[Continuum fields](https://simulation-hypothesis.com/simulations/methods#m-continuum)floor: Bodies ### Endoscopy simulators A real scope is passed into a model of the gut that displays a computer-drawn view of the lining and responds to turning and pushing. Question it answers: Can a trainee learn to steer a scope and spot disease without a patient? Leaves out: The gut's stretch and the patient's discomfort are poorly reproduced, so the feel of real procedures is missing. Runs on: about 10^9 FLOPS rough real time on a workstation. Since: 1992 Beer-Gabel and colleagues' computer-assisted training in endoscopy, from a simulator to a learning station. [source](https://doi.org/10.1055/s-2007-1010538) [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)floor: Bodies ### Language-model simulated students Language-model characters play confused or struggling learners so that trainee teachers can practise explaining and giving feedback. Question it answers: Can new teachers practise responding to learners before meeting real ones? Leaves out: The model's students are more polite and consistent than real ones and make mistakes real ones would not. Runs on: about 10^14 FLOPS rough a few model calls per turn of dialogue. Since: 2023 Markel and colleagues' GPTeach, interactive teaching-assistant training with GPT-based students. [source](https://doi.org/10.1145/3573051.3593393) [Learned emulators](https://simulation-hypothesis.com/simulations/methods#m-learned)[Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)floor: Rules ## Control and crisis ### Control-room simulators Exact copies of the control rooms of power stations, chemical plants and grids, driven by a model of the process. Question it answers: Can the operators bring the plant back safely after an upset? Leaves out: The model cannot include every valve and failure the real thing has. Runs on: about 10^13 FLOPS rough the simulator's own dedicated computer, real time Since: 1958 by 1958, early full-scope simulators for nuclear power plant operators [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Differential equations](https://simulation-hypothesis.com/simulations/methods#m-equations)floor: Populations ### Emergency exercises A scripted disaster worked through by the people who would respond to it, around a table or across a real city. Question it answers: Where does the plan break down? Leaves out: Participants know it is an exercise, so real panic and confusion are underplayed. Runs on: no computer. paper and people; sometimes a simple computer to track events Since: 1954 by 1954, civil defence tabletop exercises rehearse disaster response [Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)floor: Rules ### Business simulations Teams running a simulated company or market over several rounds, taught in business schools. Question it answers: Can the team read the market and manage the company through it? Leaves out: Simplified market rules can reward exploitation of the model, not necessarily sound management. Runs on: about 10^10 FLOPS rough a modest computer; most of the exercise is discussion Since: 1956 the American Management Association ran the Top Management Decision Game, an early computer-based business game [System dynamics](https://simulation-hypothesis.com/simulations/methods#m-system-dynamics)[Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)floor: Populations ### Air traffic control simulators A simulated sky full of aircraft, radar screens and radio calls, for training and testing controllers. Question it answers: Can the controller keep enough aircraft safely apart as traffic gets busier? Leaves out: Simulated pilots follow instructions more predictably than real ones under pressure. Runs on: about 10^12 FLOPS rough an air navigation service provider's server, real time Since: 1966 by 1966, early computer-driven air traffic control training simulators [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Discrete event](https://simulation-hypothesis.com/simulations/methods#m-discrete-event)floor: Bodies ### Negotiation and diplomacy training simulations Trainee diplomats, mediators or executives role-playing a dispute against instructors or each other, practising how to read the other side and reach a deal. Question it answers: Did the trainee find a workable deal, and where did their approach go wrong? Leaves out: Role-players usually compromise more readily than real counterparts under real domestic pressure. Runs on: about 10^10 FLOPS rough little computing; mostly people, rules and a scorer's desktop Since: 1963 by 1963, early simulated negotiation exercises for diplomatic training [Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)[Game theory](https://simulation-hypothesis.com/simulations/methods#m-game-theory)floor: Rules ### Emergency incident command simulators A live, timed exercise where commanders and staff receive escalating, unscripted updates about an unfolding emergency over real radios and screens. Question it answers: Can the command team make good decisions in real time, not just with hindsight? Leaves out: However realistic, everyone involved still knows no one will really get hurt. Runs on: about 10^11 FLOPS rough a training centre's server, real time Since: 1974 by 1974, early functional emergency-management exercises with live radio traffic [Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)[Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)floor: Bodies ### Language-model conflict rehearsal A language-model counterpart plays a difficult person so a trainee can rehearse a conflict and get feedback. Question it answers: How can a hard conversation be practised safely? Leaves out: The partner's responses are not those of a real person. Runs on: about 10^13 FLOPS rough Model calls per session Since: 2023 Rehearsal: simulating conflict to teach conflict resolution (2023) [source](https://arxiv.org/abs/2309.12309) [Learned emulators](https://simulation-hypothesis.com/simulations/methods#m-learned)floor: Rules ### Mass-casualty exercises Actors or manikins stand for many victims, and hospitals, ambulances and teams go through a staged disaster to test triage and capacity. Question it answers: Would a hospital cope if dozens of seriously injured people arrived at once? Leaves out: Staff know it is an exercise, so fear, fatigue and chaos of a real event are absent. Runs on: no computer. no computation; a day of staff, actors and observers. Since: 1989 Simon and colleagues' simulated mass casualty evaluation at Beilinson Hospital. [source](https://doi.org/10.1017/s1049023x00029885) [Rules and states](https://simulation-hypothesis.com/simulations/methods#m-rules)[Agent-based](https://simulation-hypothesis.com/simulations/methods#m-agent-based)[Real time](https://simulation-hypothesis.com/simulations/methods#m-real-time)floor: Populations [◂ Minds as simulators](https://simulation-hypothesis.com/simulations/mind-simulations)[Before computers ▸](https://simulation-hypothesis.com/simulations/before-computers)