Simulation has significantly advanced from the days of Resusci Anne and basic cardiopulmonary resuscitation training. Training has also progressed from hypothetical stories followed by only verbal responses to the current use of high-fidelity, computer-controlled manikins which allow early learners as well as advanced clinicians to explore various domains of sedation practice while preparing for unusual and/or life-threatening events. Medical simulation has the advantage of permitting deliberative practice in an active learning environment without putting patients at risk. With increasing demands for patient safety and provider accountability, simulation will continue to have an increasing role in provider training of psychomotor tasks, knowledge, and communication skills.