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This paper presents the current status of computer-based simulation in medicine. Recent technological advances have enabled this field to emerge from esoteric explorations in academic laboratories to commercially available simulators designed to train users to perform medical procedures from start to finish. Today, more than a dozen companies are producing virtual reality simulators and interactive manikins for training in endoscopy, laparoscopy, anaesthesia, trauma management, angiography, and needle insertion. For many of these procedures, thousands of animals are still being used in training. Yet simulation has many advantages that can transcend scientific, ethical, economic and logistical problems that arise when using animals. The first validation studies of medical simulators began appearing in the late 1990s, and the early results indicate that these devices measure what they are intended to, and that they can improve performance relative to traditional learning methods. In addition to expanded use for new and existing minimally invasive procedures, medical simulators will probably soon be used in physician credentialing, and they may someday allow surgeons to rehearse procedures in a patient-specific operating environment. Replacing animals with simulators in medical training is limited no longer by technical feasibility but by a willingness of the medical community to embrace it.