INTRODUCTION: Simulation based training, education and assessment is becoming commonplace in the healthcare. Large, dedicated simulation centers are emerging at a rapid rate and numerous previous studies indicate high rates of satisfaction of their users. Geographical considerations, as well as operational decisions can create barriers to the conducting of training in dedicated large centers. We compare various parameters of trainee’s perceptions of simulation based programs that were conducted in nontraditional, off-site locations to that of a large university based simulation center. METHOD: During 2004 and 2005 and a simulation based course was conducted for flight crew members of a large air medical transportation system which operates 16 helicopters with a field crew of over 200 healthcare professionals. The course was a simulation based education and assessment program to provide annual skill updates as well as competency assessment evaluations. After each training encounter trainees completed a standard on-line WISER evaluation form. We evaluate various components of the survey and compare the perceptions of those crew members who participated at the WISER center to those who participated in off-site locations such as helicopter bases, fire departments and hotels. The course at the off-site facilities included the same instructors, level of simulation hardware, computer support and audio visual equipment that is utilized at WISER. RESULTS: Likert scale evaluation data from 361 respondents were reviewed as well as free text entries. 281(78%) crew members participated on-site at the WISER Institute location and 80(22%) had participated at off-site locations. We calculate a median and interquartile ratios (IQR) for on site versus off site. We then evaluate any significance difference by determining a p-value by using the Wilcox rank-sum test. Overall course rating (OffSite (Med 8; IQR:(7 – 9)), OnSite (Med 8.5; IQR:(8 – 9)) p= 0.0001); Appropriate for my level of learning ((Off Site Med 8; IQR:(7 – 9)), OnSite (Med 9; IQR:(8 – 9)) p= 0.0067); Scenarios were realistic ((Off Site Med 8; IQR:(6 – 9)), OnSite (Med 8; IQR:(7 – 9)) p= 0.7439); Scenarios were challenging ((Off Site Med 8; IQR:(7 – 9)), OnSite (Med 8; IQR:(7 – 9)) p= 0.9168); Scenarios were appropriate for level of education ((Off Site Med 8; IQR:(7 – 9)), OnSite (Med 8; IQR:(7 – 9)) p= 0.1181); Simulation training has improved my confidence ((Off Site Med 8; IQR:(6 – 8)), OnSite (Med 8; IQR:(6 – 8)) p= x); Debriefing was helpful ((Off Site Med 9; IQR:(7 – 9)), OnSite (Med 9; IQR:(8 – 9)) p= 0.5708); Debriefing was completed in a professional, non threatening manner ((Off Site Med 9; IQR:(8 – 9)), OnSite (Med 9; IQR:(8 – 9)) p= 0.6272); Overall facility rating ((Off Site Med 7; IQR:(6 – 9)), OnSite (Med 9; IQR:(8 – 9)) p= 0.00); I am uncomfortable with simulation based competency because it is unrealistic ((Off Site Med 1; IQR:(1 – 2)), OnSite (Med 1; IQR:(1 – 2)) p= 0.3714) CONCLUSIONS: The ability to conduct successful simulation center based programs in off-site locations is possible without significantly affecting trainee’s perceptions, expectations or opinions about simulation training programs.