Training setting Training occurred at an academic urban health sciences center during spring 2009 within a previously described virtual OR (VOR)32 at the School of Medicine’s Russell C Klein MD (‘59) Center for Advanced Practice. Equipment included a full-scale computer-operated human patient simulator (HPS) mannequin (CAE Inc.) and an inanimate torso procedural training model (Simulab Corporation). The HPS mimics complex physiologic responses. The torso model has a replaceable outer skin, an upper abdomen mold, removable small bowel, and a replaceable model of an abdominal aorta capable of “bleeding” via a portable pump and fluid reservoir. Additionally, a recess in the HPS upper arm allowed placement of a hollowed-out tissue pad (Simulab Corporation) to simulate a soft-tissue mass. Simulator set up has been described previously.33