Computer-based virtual reality technology has evolved to the point at which medical simulation can be incorporated into medical education and into the eventual objective evaluation of surgical competence. Flight simulation provides a model for examining the role of computer-based simulation in medical training and certification. The plan by which medical simulators are being designed and validated for surgical training is presented, as is a description of the current state of medical simulation and the limitations of the technology. A realistic argument for adoption is suggested that takes into account lower price constraints, technological limitations, and professional barriers to the implementation of simulator-based training and accreditation. 1

Virtual endoscopy is a diagnostic technique in which a three-dimensional imaging technology (CT scan, MRI scan, ultrasound) is used to create a computer-generated representation of a specific patient's anatomy or organ, and then the virtual organ is “flown through,” giving the same visual impression and image as if the corresponding real organ had a video or fiberoptic endoscopic procedure performed. The potential is to provide a computer diagnosis to replace an endoscopic procedure, not only for conventional endoscopy such as bronchoscopy, colonoscopy, sinusoscopy, or hysteroscopy, but also for areas where traditional endoscopy is not possible, such as the inner ear, spleen, lymphatic tissues. With sophisticated signal processing and computational analysis, it may be possible in the future to perform a “numerical biopsy,” that is, make a tissue diagnosis based upon spectral or other information contained in the images.

There are a number of modalities for implementing Virtual Environments (VE) for medical training and simulation. Integrating them for a seamless transition from one to another presents the next challenge. The three applications of (1) individual anatomic education and training, (2) medical crisis planning and training, and (3) medical virtual prototyping have been integrated into a single program approach by the military for battlefield trauma care. With this model as a template, the power of VE for the many different aspects of medical education can be explored and exploited.