Simulations: how real is real enough?

How realistic does a simulation have to be? The answer is: just high enough to achieve your specific learning objectives.  

Many medical games have some simulation component as part of the game play. The idea of producing a simulation can be daunting because of the difficulty of accurately reproducing a “real” environment or situation. But if you consider the amount of realism actually needed to teach specific learning objectives, you may find that not only will a simplification
of reality do, it may be better than presenting a more realistic representation. 

According to Chris Crawford, a simulation is an attempt to accurately represent a real phenomenon, whereas a game is an artistically simplified representation:

A simulation designer simplifies only as a concession to limited
resources. A game designer simplifies deliberately in order to focus
the player’s attention on important factors. A game deliberately suppresses detail to accentuate the broader message that the designer wishes to present. …” [Crawford, 1982]

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Even in a fairly realistic simulation it is necessary to make choices about what components will get a less realistic treatment. In this surgical simulation from MySmartSimulations the use of surgical tools is greatly simplified, in favor of emphasizing procedural concepts.

Another example is a proposed Blood Vessel checking game (idea contributed by Pamela Andreatta of the UMHS Sim Center) for OB/GYN residents training in laparoscopic surgery.
The goal of the game would be to select and use the right seal or closure for various size and types of blood vessels and then check the sealed vessels at lower air pressures to determine if they will hold or not. 
This game would teach cognitive skills,
not psychomotor skills. The representative aspects of the game will be confined to almost cartoonish versions of blood vessels, just whatever is needed to help the player make the kinds of decisions
necessary for this type of blood vessel closure.