In a new article from Prehospital & Disaster Medicine, renown authors from Los Angeles report that unsurprisingly, it appears that ACTUAL people are a more effective learning stimulus than simulators.  Due to the increasingly difficult time acquiring role-players and the perceived variation between actors, electronic simulation is now thought by many in Emergency Medicine to be a panacea of medical education.  Tens of thousands of dollars are spent on Sim-Man models at universities and medical centers across the country, with faculty members now specializing in operating these mannequins.  Ironically, learning to operate these machines to talk and respond to interactions from the learners is becoming a full time job.  Now, please do not take this as a condemnation of simulation, but there are limits on their efficacy.  Anyone that believes that their simulation can effectively reflect the anxiety of a trauma injured casualty pulling on your pant leg and shouting at you to help them, while you attend to three other casualties, is kidding themselves.  Of course actors cannot act the signs and symptoms of a pneumothorax, but the Sim-Man's canned verbal interactions are unrealistic as well.  Accordingly, there needs to be a balance between real-life and simulation in educational situations.  As educators, we must recognize the value of each and plan our curricula accordingly.  

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