Into the Valley: The Role of Simulation in Training

Date Posted:Wed, 15th Nov 2023

Into the Valley: The Role of Simulation in Training

Iqarus International Ltd, as a medical training organisation, specialises in preparing individuals and organisations for real-world challenges. Our perspective of the ‘real world’ encompasses regions impacted by natural disasters, conflicts, and the destruction of vital infrastructure.


For those who have participated in Iqarus training, you know that we emphasise practical experience to help students develop the confidence and competence required for complex decision-making and skills in suboptimal conditions.

At Iqarus, we have invested significantly in high-fidelity simulation as a fundamental part of our training. We aim to make the training environment as identical to real-world conditions as possible, going beyond just visual aspects. This means recreating sounds, smells, and atmospheric conditions to engage all the senses, and there's a good reason for it.

When we think about training, especially logical decision-making, we're essentially trying to change the way our students think because learning primarily occurs in the brain. While we'd like to think that our training directly influences the most advanced part of the human brain, the prefrontal cortex (PFC), which handles memory integration, regulates behaviour and manages emotional responses, the reality is more complex. The PFC is essential for promoting task-relevant operations and allows us to identify mistakes and change our behaviour in response to a changing environment.

Under extreme stress, similar to what we simulate in our training, the prefrontal cortex can be overridden by the limbic system, or the ‘emotional brain’. The limbic system, one of the oldest parts of the brain, is responsible for emotional and behavioural responses, supports learning and memory formation, and plays a crucial role in managing stress.

These are all the functions we aim to promote and enhance through training, but the reality is that the PFC does not have everything its own way. In times of stress, particularly the types of stress that we are preparing our students for, and therefore aim to simulate in training, the PFC can and is overruled by the limbic system, also known as the paleomammalian cortex.

The amygdala, a component of the limbic system, is responsible for triggering immediate responses to perceived threats. It's best known for the fight, flight, or freeze response, and it encodes emotional memories. During stress, this part of the brain can temporarily hijack the rational responses of the prefrontal cortex, leading to what psychologists call "The amygdala hijack”.

This phenomenon was described by psychologist Daniel Goleman in his 1995 book, "Emotional Intelligence: Why It Can Matter More Than IQ." In it, he explained the impact of the hijack when the amygdala responds to stress and inhibits the rational, reasoned responses of the PFC. Understanding the phenomenon and its effect on suppressing the PFC is crucial in designing appropriate and effective training. This raises the question: Can simulation in training be 'too real'?

The immediate answer is no.

Considering that we are preparing our students for an operational environment filled with acute and chronic stressors, it's crucial that they encounter these stresses during their training. This highlights the art of training, and its meticulous design and delivery are essential to ensure that the appropriate stressors are integrated progressively and in a safe and supportive learning environment. To ensure the training is effective and fit for its purpose, deliberate, calculated, and controlled stressors should be incorporated into the Course Training Plans. These stressors should be included alongside other more commonly considered factors such as Learning Outcomes, delivery, and assessment strategy.

Until this point, we've primarily referred to simulation as part of live, scenario-based practical training. As we progress further into the 21st century, there is a growing demand for and utilisation of virtual reality (VR) in training. VR training has proven its worth in practical training and has long been employed by various sectors, including the military and aviation industries.

For the kind of training provided by Iqarus, VR offers the same advantages. VR training ensures consistency, providing each student with a uniform, measurable experience that involves repeatable challenges and decision-making processes. Additionally, there are significant potential cost savings associated with the ability to create entire virtual environments. Even training for hostile environments can be made substantially safer while still eliciting the necessary emotions and stressors.

But can VR training be too realistic?

The answer, in the case of VR training, is yes, it can be too real. As we move closer to achieving absolute realism, we encounter a phenomenon known as the "uncanny valley". This refers to the unsettling feeling that people experience when simulations closely resemble humans in many ways but fall just short of full believability. The term "uncanny valley" comes from the way participants' comfort levels drop as a simulation gets closer to but doesn't quite reach complete authenticity.

The "uncanny valley" effect has caused several mishaps in the film industry. For instance, in 2001, DreamWorks invested around $60 million in creating an animated movie featuring a green ogre named Shrek. However, when they screened the film for a test audience, children started crying. The problem was that the animation was so advanced that it fell into the uncanny valley, particularly with the princess character. To remedy this, the entire movie had to be reanimated, making the princess character appear more cartoon-like and less human. This phenomenon isn't limited to children; a more recent example is the movie adaptation of "Cats," based on Andrew Lloyd Webber's hit Broadway show. The uncanny valley effect was so profound that it's rumoured to have led Lloyd Webber to get a therapy dog due to the emotional toll the film took on him.

As we approach the ability to create increasingly realistic VR simulations, it becomes clear that we can make them too realistic. Such hyper-realistic content doesn't just distract from effective learning; it can actually distress our students. In his 1970 essay "The Uncanny Valley," Japanese roboticist Masahiro Mori described and quantified this phenomenon. He proposed that a simulated human achieving 96% realism or higher, without being 100% human, would trigger an adverse uncanny valley response. Above 96%, the simulation ceases to be perceived as a high-fidelity one and starts to be seen as a human with something amiss.

These insights have implications for training. We need to be cautious and not let technology blind us to the fact that more realism isn't always better. The degree of realism in simulations should be carefully managed to ensure it's effective, rather than just proving that we can make something incredibly realistic. As educators, we also need to manage our students' expectations. Many of them, especially the younger generation raised in an era of rapidly advancing gaming technology, might expect wholly realistic simulations. Hence, it's essential to provide them with a thorough briefing on the virtual experience, explaining the degree of realism used and the reasons behind it. This should complement the standard pre-training aims and objectives, which set the parameters for student success.

However, it's worth noting that this may not always be the case. Moore's Law, which suggests that computer processing power doubles every two years, coupled with the nature of computing, where every innovation begets numerous new breakthroughs, might lead us to a day when we can develop

100% accurate simulations capable of passing both visual and emotional Turing tests. When that day comes, training in the virtual realm will undergo a radical transformation, and our possibilities will become boundless. Until then, we will continue to blend and blur the lines between the virtual and the physical.

Visit for more information on our Immersive Training Courses.