The revolution in medical education-the role of simulation.

The last major change in medical education was the Flexner Report, over a century ago. Since that time, iterative improvements have occurred to the question-and-answer and "see one, do one, teach one" educational environment. However, multiple external forces-from the 80-hour work week to the emphasis on patient safety to competing demands on student and faculty time-have raised calls for a fundamental revamping of the entire medical educational process. Fortunately, new methods, curricula, and processes, such as Accreditation Council for Graduate Medical Education competencies or Objective Structured Assessment of Technical Skills, as well as innovative technologies such as web-based learning and simulation, have provided opportunities to support the revolution in medical education that will be responsive to national priorities, the public concern, and, most of all, to patient safety.