I am old enough to remember the 1960s when audio systems were nicknamed hi-fi's. Originally, the term was used as a shortened version of high fidelity to indicate the ability to accurately reproduce the sounds of audio performances by recording and playback devices. The 1960s were the era of vinyl recordings (records) and the availability of records in monaural or stereophonic formats. Although we would struggle to avoid scratching or leaving fingerprints on the vinyl surface, we did not seem to mind the inherent high-frequency “hiss” of this then-considered high-fidelity form of music recording. High fidelity was redefined with the advent of magnetic tape cassettes, and even further with the arrival of digital formats in the form of compact disks. Although audiophiles still debate the true fidelity of compact disks compared with analog formats, there is little dispute that the fidelity of recorded music to an actual performance has dramatically improved over the past 4 decades. Since the 1960s, the fidelity of simulators that attempt to mimic patients has also made great strides. Many of us can recall the early versions of human simulators. These were manikins designed with airways, extendable necks and jaws, and bags representing lungs. We took what was then called cardiopulmonary resuscitation (CPR) training on Resusci Annies. Initially, CPR training focused on establishing an airway, delivering breaths, and performing chest compressions. We would learn to perform CPR according to national specifications, alone and in 2-person teams. For anyone needing to perform CPR on an actual person, this was reasonable training, but was limited to providing first aid until more complex care could be provided. In the beginning, the quality of simulated CPR delivery was determined by instructors who visually gauged if proper volumes and timing of breaths, and appropriate location and depth of compressions were being delivered. A step toward improved fidelity arrived with the development of advanced cardiac life support (ACLS) courses in the 1970s. This program introduced the learning and practicing of established protocols and algorithms; it did this by providing education in the pathophysiology of ischemic heart disease-related cardiac abnormalities, the pharmacology of drugs used to treat these cardiac conditions, and the means used to diagnose and manage various cardiac and airway emergencies. Those wishing to certify in ACLS were required to pass written examinations and then lead a mock code team through various emergency cardiac scenarios. Although the mechanical simulators used for ACLS were little better than those used for CPR (now termed basic life support) training, ACLS instructors provided verbal scenarios, altered the path of the scenarios based on a student's actions or inactions, and determined if a student had sufficiently mastered the material. Thus, the instructors were the primary “simulators” as opposed to the mannequins. Although the actual simulators used for early basic life support and ACLS training no longer qualify for being called “high fidelity,” they did provide a valuable chance for individuals to learn and, more importantly in my mind, rehearse for life-threatening situations. There is little debate that rehearsal is the best means of preparing for complex tasks. There is a reason why someone like Phil Michelson can chip so well. He rehearses his chipping hundreds of times each week. This is even truer when actual life situations will be stress provoking, as is true for most patient emergencies. I have had the privilege over the past few years to be an observer for a course developed by a talented group of dental and medical anesthesiologists, and oral-maxillofacial surgeons. Part of their pioneering work was funded by a grant from the American Dental Association. The course's goal is the safety of dental office-based conscious sedation. The course is not designed to teach sedation techniques; rather, it is targeted at honing the skills of dentists in the recognition and management of common sequelae and complications of sedation, such as hypoventilation, cardiac dysrhythmias, and untoward reactions to anesthetic agents. The simulators also give instructors objective feedback to help them guide participants when their efforts are out of standards for measurements such as the tidal volume of Ambu-bag-delivered breaths or the depth and rate of chest compressions. Similar to ACLS, these courses depend on highly skilled course instructors to help participants with training, and to then work through scenario management. What differentiates these dental anesthesia courses from typical ACLS courses is the use of high-fidelity simulators. These sophisticated manikins contain components and electronics that allow instructors, through the use of laptop computers, to closely simulate most essential vital signs of the cardiopulmonary system. Simulated physiology includes the ability to hear normal and abnormal breath sounds, palpate central and peripheral pulses, and determine if the airway is obstructed. When the simulator is “breathing,” the chest rises and falls. The nasal, oral, and pharyngeal aspects of the simulator accept artificial airways, and the chest is designed to allow cardiac compressions and determine if they are effective. The simulated patient can have monitors that reflect, through commonly used monitoring equipment, an electrocardiogram, pulse oximetry, and respirations. The simulator also has a voice and can verbalize symptoms and issue sounds of distress, such as sounding like it will soon or is vomiting. An actual intravenous line is put into place, and participants are expected to draw up the proper drugs and give appropriate doses depending on what is happening. The manikin can also accept the intramuscular administration of medications. Current human simulators still have a large amount of room to improve; they are at the audiocassette level of fidelity, but they still surpass early CPR manikins. The simulators are used to run scenarios that put participant dentists through realistic emergency situations, allowing them to rehearse their responses to various life-threatening problems. Participants work in teams to master the leadership skills needed in high-pressure circumstances. The simulator “reacts” appropriately to the treatment rendered, whether that is to improve, stay the same, or deteriorate. After each scenario, the instructor performs a thorough debrief with the participant teams and then can repeat the scenario or move on to another one. It is easy to see, as an observer, how individuals and teams dramatically improve as they repeatedly encounter problems and rehearse their reactions. There is no doubt in my mind that everyone comes away from these courses wiser, more confident, and with a greater probability of appropriately responding if faced with a sedation-related emergency. There is, however, some question as to how long this improved readiness endures. The recognition of the value of clinical rehearsing has helped propel the growth of high-fidelity simulators. Nursing schools have been leaders in this area. I was at the University of Maryland when their new nursing building opened, containing a wonderful simulation suite. The suite had true-to-life manikins representing the various types of patients and patient-care environments in which nurses deliver care. I also was fortunate to visit the Mayo Clinic and saw their impressive simulation suite with mock operating rooms, emergency bays, intensive care units, and other clinical areas. Their central command center allowed faculty to pose problems in each type of area and monitor how individuals reacted to those situations. Sessions were recorded and used to debrief those being put through their respective challenges. Doctors, nurses, and other health care providers used the Mayo suite. In some cases, it was to learn how to function as a team in nonemergency situations. However, urgent or life-threatening problems received the most focus. This is because those are the situations in which care-provider stress can interfere with clear thinking and decisiveness. This is when rehearsing plays such a vital role. It helps create a kind of intellectual “muscle memory,” so reactions to certain types of emergencies become almost automatic. Simulators can also play an important role in training. I had the chance to use a bronchoscopy trainer that uses virtual-reality technology. In this case, the individual uses a realistic looking flexible bronchoscope with normal levers for directing the scope tip. The scope is put into an opening; once inserted, the trainee peers through the eyepiece and maneuvers the bronchoscope in the usual manner. The image through the eyepiece is actually virtual reality and the image changes as the user manipulates the controls and moves the scope. A few tries give trainees confidence they could maneuver the scope in an actual patient. Such virtual-reality simulators are available for other forms of minimally invasive surgery. Whether through electronically sophisticated manikins or virtual reality, high-fidelity simulation is a training and knowledge-refreshing strategy that is coming of age. More and more academic health sciences campuses are establishing simulation suites and courses, such as those currently available from groups such as the American Dental Society of Anesthesiology, that are well beyond the beta testing stages and ready for wider adoption. In fact, recently a team sponsored by the American Association of Oral and Maxillofacial Surgeons came very close to winning the SimWars competition run at the 2012 International Meeting on Simulation in Healthcare. Contemporary simulation technology is not inexpensive. Manikin-style simulators are costly to purchase or rent. Also, like any elaborate software, virtual-reality programs are expensive to develop. However, like all technology, time and competition will bring down the costs. In the meantime, some are calling for the use of simulation technology in office anesthesia evaluations. Research is needed of the measurable improvement in performance the use of simulators provides and its duration before such a step is considered. As oral-maxillofacial surgeons, we can benefit from being able to periodically rehearse the management of emergencies occurring in our patients. All practices, private or academic, should run mock emergency sessions for their clinical teams on a periodic basis. Furthermore, residency programs could benefit from the use of simulators, and not only for anesthetic emergency training, but also for surgical procedures. It would be wonderful to use virtual reality to prepare residents for minimally invasive procedures such as temporomandibular joint arthroscopic procedures, sinus endoscopy, and semiclosed subcondylar fracture management. In time, the combination of virtual reality and haptic technology might allow the training of open surgical procedures in a simulated environment. Perhaps we have some members of our specialty with computer engineering or computer gaming education that could help us move in those directions. In the end, I urge any oral-maxillofacial surgeon who performs office-based sedation or general anesthesia to seek out courses offering the chance to work with the new generation of high-fidelity simulators. Take your entire office staff with you to such a course. They are stimulating and fun. Plus, they offer you the golden opportunity to rehearse for success.