Use of simulation is growing worldwide. A database maintained by the Bristol Medical Simulation Centre lists more than 1500 dedicated manikin simulation facilities. In Israel, for example, internship doctors are required to attend a five day workshop simulating a variety of challenging scenarios. It has a simulation based exam for anaesthetists, and certification exams for paramedics and all advanced nursing specialties also include simulation. In the United States, anaesthetists who gained board certification after 2000 are now required to do a day of simulation training for recertification. And last year the UK government's chief medical officer recommended that simulation be integrated into british postgraduate trining.