Model-Driven Simulators

Model-driven simulators (MDS), also called high fidelity simulators, are those that use a manikin body or part of a body to physically represent the patient, and have physiologic and pharmacologic models that direct real time autonomous reactions to interventions and therapies.  These types of simulators generally integrate multiple system models to produce a realistic patient response.  Suspension of disbelief is not only possible, but easy for the majority of users due to the life-like reactions.

These systems can be used to teach normal and abnormal physiology and pharmacology, equipment usage, patient and provider safety, resource management, crisis management, and many other areas.  They can teach at many different educational levels, depending on how the patient is programmed.

While this style of simulator is the top of the line, it also can be relatively expensive to set up, depending on the model chosen.  The simulator is usually sold by itself, so monitors and ancillary equipment must often be purchased separately to create a realistic setting.  The more time and money that are spent to outfit the simulation area, the more realistic the experience.  Each individual must decide how important interaction and realism are to the educational goals of the session.

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Below is an alphabetical list of high fidelity simulators with a brief description of the capabilities of each.


Note: Two simulators do not contain descriptions.  They are no longer commercially available, but are currently in use: the Leiden Anaesthesia Simulator (Leiden University) and PatientSim (MedSim). 

BabySim (CAE-METI)

BabySim represents an automatically reactive 3-6 month old infant. Vital signs such as EKG tracings (normal and abnormal) and pulmonary arterial pressures (multiple positions as catheter is floated) are viewed on standard patient monitors. Cardiac output, urine output, end tidal carbon dioxide, manual blood pressure, and other measurements can also be performed. The fontanelles are palpable and can indicate intracranial pressure abnormalities. The manikin is capable of additional patient signs, such as crying, pulses in multiple locations, heart / lung / bowel sounds, and secretions are also present. The manikin responds automatically to treatments such as oxygen administration, drug bolus or infusion. 

Emergency Care Simulator (CAE-METI)

The Emergency Care Simulator (ECS) contains a full body manikin, with physiological and pharmacological models which are optimized for emergency and trauma scenarios. Several training programs are supported, including Advanced Life Support (ALS), Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and Advanced Trauma Life Support (ATLS). The system is portable, to allow training of prehospital personnel in the field. Real patient monitors are used to allow equipment training. 

Human Patient Simulator (CAE-METI)

The Human Patient Simulator (HPS) is a full body manikin with accompanying integrated physiologic models for the cardiac and pulmonary systems. It also includes a pharmacologic model for approximately 50 intravenous drugs (bolus and infusion) and 5 inhalational agents (anesthetics). Standard patient monitors can be used to monitor and, in some cases, treat the patient. Over 100 physiologic parameters can be adjusted to simulate a disease state's signs and symptoms. 


I-Stan is METI's adult wireless portable manikin. The model has an internal skeleton which allows for more lifelike motion. The cardiac system includes a 5 lead EKG and defibrillation / pacing with real equipment, pulses at seven different locations bilaterally, jugular venous distention and Korotkoff sounds (5 phases). The pulmonary system includes features such as multiple difficult airway settings, flail chest segment, and real-time carbon dioxide monitoring. Arterial and venous hemorrhage and secretions at multiple locations are available as well and are integrated into the physiological modeling system. 


There are two versions of MetiMan, one for nursing education and one for prehospital education.  Each version has slightly different skills that can be practiced on the manikin, but they use the same basic operating system.  The manikin is wireless and uses a web-based control program (Muse) that is compatible with Mac and PC.  Muse allows the person controlling the manikin to use the model-driven physiological features, but also has the option of overriding the modelling to demonstrate unusual or very specific patient presentations.  Signa and symptoms are displayed on the manikin (loss of pulses, pupil reaction, etc) or the simulated patient monitor (vital sign changes). 

Orpheus Perfusion Simulator (Manbit Technologies)

The Orpheus Perfusion Simulator is designed to introduce trainees to cardiopulmonary bypass procedures. It also has the capability to show abnormal states and critical events. The program which runs the simulator includes physiological, pharmacological and thermal models. There is a hydraulic system included, a modified cardiac anatomy (one half of a heart), valves and vessels. Real monitors read electricity from the ventricle as it is connected to an actual bypass machine. Resistance and compliance of the aortic valve and contractility changes in the ventricle add to the realism. 

PediaSim (CAE-METI)

PediaSim is a wireless pediatric full body manikin, based on the Human Patient Simulator. The model physically appears as a medium sized child, and contains the appropriate integrated physiologic modeling of a pediatric patient. Pharmacological models support over 50 intravenous and inhalational drugs. Standard patient monitors are used to demonstrate invasive and non-invasive vital signs and gas mixtures being exhaled. The patient exhibits disease-specific signs from the cardiovascular and pulmonary systems, as well as neurologic and genitourinary signs. 


The pediatric version of the Emergency Care Simulator is based on Human Patient Simulator modeling. The 5-7 year old child breathes, blinks, exhales carbon dioxide and talks (via a microphone). The manikin is responsive to the environment and to user interventions, such as chest compressions and changes to the oxygen content of the air it is "breathing". Simulated drugs are administered through either the manikin or the computer interface. The manikin can be paced, defibrillated (mono- or bi-phasic) and cardioverted. Heart, lung and bowel sounds are synchronized and can be normal or abnormal. Secretions such as tears and blood indicate head trauma.