The Evolution of Simulation in Healthcare: High Fidelity, AI, and the Role of VR/AR.

IMSH 2025 marked a significant milestone—not just because it celebrated the 25th anniversary of this premier event, but also because it coincided with my own journey in medical simulation, now spanning 25 years. Over this quarter-century, I’ve witnessed technologies evolve, products come and go, and new ideas transform into groundbreaking solutions. Yet, one thing remains constant: the shared goal of improving medical training to save more lives.

The Role of Fidelity in Simulation:

Simulation in healthcare has traditionally been categorized into low fidelity, mid fidelity, and high fidelity systems. Each has its purpose:

• Low Fidelity : These are often simple, cost-effective tools like basic manikins or task trainers that focus on specific skills, such as IV insertion or CPR. They are akin to a manual bicycle—reliable, accessible, and easy to use, but limited in complexity.
• Mid Fidelity : This category bridges the gap, offering interactive dummies with some physiological responses, providing an enhanced learning experience.
• High Fidelity : At the top are hyper-realistic, fully functional simulators with advanced sensors, responsive AI, and lifelike behavior. These systems are the “self-driving electric motorcycles” of simulation—impressive and effective but complex, expensive, and dependent on technical support.

The trade-off between fidelity levels is a matter of cost, complexity, and learning objectives. While movie-like humanoids offer an unmatched immersive experience, they come with higher maintenance costs and technical dependencies. Simpler models, on the other hand, remain invaluable for foundational skills training.

AI and Mechatronics: The Backbone of Modern Simulators:

Three years ago, we introduced an offline AI system integrated into ADAM X, our high-fidelity humanoid simulator. This AI could interact dynamically with trainees, adapting to evolving scenarios in real-time. What we didn’t anticipate was the system’s broader application. A year later, this AI evolved into DEST (Digital Emergency Support Team), designed to assist first responders, firefighters, and defense forces in high-stakes situations.

DEST, now a CES Innovation Award-winning system, exemplifies how AI can transcend traditional simulation boundaries, offering real-time decision-making support where every moment counts.

VR and AR: Enhancing, Not Replacing;

Virtual Reality (VR) and Augmented Reality (AR) have been hailed as game-changers for medical training, and their integration with AI offers exciting possibilities. While VR and AR provide immersive environments for scenario-based training, they have yet to match the tactile feedback and situational awareness offered by physical simulators.

For now, VR and AR are excellent complementary tools, offering:

• Cost-effective, scalable training for theoretical and procedural knowledge.
• Opportunities to simulate rare or hazardous scenarios.

However, the technology still faces challenges in providing the sensory realism and emotional engagement that physical simulations offer.

The Future of Training

2025 feels like a pivotal year for medical simulation, as the industry increasingly embraces the convergence of technologies—AI, mechatronics, VR, and AR. The goal is not to replace one approach with another but to integrate these tools to create comprehensive training ecosystems.

As we look forward, the focus must remain on accessibility, scalability, and the ultimate objective: saving lives. In my next blog, I’ll dive deeper into what lies ahead for medical training and how we can continue to innovate for better outcomes.

Stay tuned!

Dervis Demirtas