Both technical and behavioral performance can be assessed from videotapes of simulations. The behavioral rating system can be improved; one particular difficulty was aggregating a single rating for a behavior that fluctuated over time. These performance assessment tools might be useful for educational research or for tracking a resident's progress. The rating system needs more refinement before it can be used to assess clinical competence for residency graduation or board certification.

The teaching of a structured method of communication improved the communication during telephone referral in a simulated clinical setting. This research has implications for how healthcare professionals are taught to communicate with each other.

Crisis resource management courses demonstrate the value of simulation in bridging the gap between 'knowing' and 'doing' and keeping the focus on patient safety. Recommendations are made for ways in which the core elements of crisis resource management philosophy can influence the conceptualization of a new medical curriculum.

The spectrum of uses of high-fidelity simulation in emergency medicine has increased in the past 10 years and ranges from teaching isolated skills to improving complex team behaviours in critical situations. This review will describe these published uses and explore the evidence supporting the use of high-fidelity simulation, as well as the future directions and difficulties of using this technology in our specialty.

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