About Open Sim Lab

What it teaches, and how

Most of what makes anaesthesia hard is invisible. The drug you pushed thirty seconds ago is still on its way to where it works. The pressure that just fell did so for a reason that determines what will fix it. The saturation that looks fine is about to stop looking fine, and how much warning you get depends on the patient in front of you.

A textbook can tell you those things. It cannot show you them happening on a patient you are responsible for. That is what this is for: you give the drug, and you watch the plasma concentration spike while the effect-site concentration climbs slowly behind it, and you see the pressure follow the second curve rather than the first.

Every session ends in a structured debrief that names what happened, ranks why it happened using the engine's own attribution, and computes what the alternative would have produced by re-running the simulation on your decisions with one thing changed.

Who it is for

It is built first for medical students on an anaesthesia rotation, in particular the one opening it the night before their first day in theatre. After that: anaesthesiology residents in their first year, nurse anaesthetist students, and the faculty who teach all three.

It assumes basic cardiovascular and respiratory physiology and no anaesthesia experience at all. It is not built for practising anaesthetists, but it needs them, because no clinician has yet checked whether this patient behaves the way a real one does. If that is you, the governance page says exactly what is unreviewed and there is a control on every clinical claim for telling us it is wrong.

What is actually in it

Every module is a set of short cases, each built around one thing going wrong and one decision worth rehearsing. An anaesthesia induction where the pressure falls and the reason determines the fix. A ward patient whose early-warning score stays reassuring while they deteriorate. A cancer-treatment complication that arrives weeks after the exposure that caused it. None of them takes longer than a coffee break.

The catalogue is not printed here, because a list of 240 titles is not writing and it goes stale the moment a scenario is added. Every module has its own page listing its cases with what each one teaches, and every case has a page of its own, both generated from the same registry the simulator runs from. Those cannot drift from what ships; a paragraph on this page could, and once did, for as long as it took someone to notice.

What is common to all of them is the machinery: a sweeping monitor driven by the real waveform engine, population pharmacokinetics for the drugs that have published models, a clearly labelled teaching model for the ones that do not, and a structured debrief that re-runs your own decisions with one thing changed so you can see what the alternative would have produced.

• A sweeping monitor with electrocardiogram, arterial pressure, capnography and plethysmography, all phase-coherent.
• Propofol and remifentanil, with their compartment kinetics and interaction, pediatric propofol kinetics from Paedfusor, plus a clearly labeled teaching model of rocuronium onset and spontaneous recovery.
• Apnoea and desaturation that follow the published times rather than a stopwatch, and a circulation that fails the way an unrelieved airway problem actually makes it fail.
• Laryngoscopy with a Cormack-Lehane grade, where repeated attempts make things worse.
• A PEARLS debrief with computed counterfactuals.

See every module and what it covers

Where the pharmacology comes from

Every model parameter is transcribed by hand from its primary publication into typed source in this repository. There is no external dataset, nothing vendored, and nothing fetched at build or run time. Each model carries its citation, the table it was read from, and the range of patients it was derived in.

Applying a model outside that range does not silently produce a number. It marks the model out of range, names which covariate is out of bounds and by how much, and offers one that is not, and it still runs, so you can see what going out of range actually does.

The project requires that every parameter be independently checked by a second person against a second source before a model may be called published. That check has not been done for this build, so no model here carries that label, and the interface says so wherever a model drives a number.

Read the validation report

How the clinical content is reviewed

Every scenario, protocol, drug card and explainer is meant to carry a machine-readable review record naming a credentialed clinician, their competing interests, the sources they consulted, and the date it is due for re-review. The build excludes anything without one.

In this build, nothing is signed. The editorial board is empty and recruiting it is ongoing. The governance page lists every outstanding item by name rather than reporting a reassuring percentage.

Read the governance records

What it deliberately does not do

It does not teach psychomotor skills. You cannot learn to hold a laryngoscope from a screen, and this does not pretend otherwise. It does not teach physical airway technique, and it does not model team communication at all, which is a large part of what goes wrong in real crises.

It does not replace mannequin-based simulation or supervised clinical time. The evidence that screen-based simulation helps is evidence that it helps BEFORE those things, not instead of them.

And it is not a clinical tool. It predicts what a virtual patient does. It never advises what to do to a real one, there is no field anywhere that accepts a real patient's details, and the simulation core is structurally incapable of turning a target concentration into a dose.

Read the limitations register

How to use it in a course

It needs no licence, no procurement, no accounts and no institutional integration. Send your students a link and they are in, or clone the repository, run the documented build, and host the resulting files yourself from any static host, on your own domain, with no dependency on this project staying online.

Because practice stays on the device, you cannot see what a student did unless they export a transcript and send it to you themselves. That is a deliberate trade: the confidentiality simulation standards ask for is easier to guarantee when the data was never collected.

Scenarios are plain JSON validated against a published schema, so an educator can write one by hand, validate it in the browser, and run it without touching the application source or installing anything locally. If you build one worth sharing, the repository will take it.

Modules

• Anesthesia

  Induce and maintain general anaesthesia on a virtual patient, and watch what the drugs actually do to the physiology while you do it.

  Available
• Emergency medicine

  Assess an undifferentiated emergency patient, test the next useful hypothesis, and reassess the response in short, focused rehearsals.

  Available
• Cardiology

  Read symptom trajectories, estimate clinical likelihood before testing, and make each cardiology decision earn its place.

  Available
• Respiratory medicine

  Practice calm reassessment of obstructive, hypoxemic, pleural, sleep-related, and neuromuscular respiratory failure.

  Available
• Pediatrics

  Practice calm whole-child recognition, reassessment, escalation, and handoff across pediatric emergencies.

  Available
• Neurology

  Practice calm neurological pattern recognition, serial reassessment, escalation, and handoff across acute brain, spinal cord, neuromuscular, and autonomic emergencies.

  Available
• Toxicology

  Practice calm recognition, support, antidote boundaries, serial reassessment, and handoff across high-risk poisonings.

  Available
• Obstetrics

  Practice calm recognition, coordinated response, reassessment, and handoff across delivery-room and postpartum emergencies.

  Available
• Neonatology

  Practice calm newborn transition, escalation, reassessment, and handoff while keeping the parent-newborn dyad together.

  Available
• Endocrine and metabolic medicine

  Practice calm metabolic trajectory review, treatment boundaries, transition readiness, and recurrence-aware handoff.

  Available
• Renal and electrolyte medicine

  Practice calm kidney and electrolyte reassessment, immediate protection, treatment boundaries, and recurrence-aware handoff.

  Available
• Infectious disease

  Practice calm recognition of dangerous infection, timely activation, treatment boundaries, serial reassessment, and handoff.

  Available
• Nursing

  Practice recognition, escalation, and honest handoff on the ward, where the tools are imperfect and the deterioration is quiet.

  Available
• Oncology

  Practice the recognition problems cancer treatment creates: an exposure that has already stopped, a complication that arrives late, and a decision that belongs to another team.

  Available
• Surgery and trauma

  Ten bounded surgery and trauma rehearsals spanning the deteriorating post-operative patient, injury patterns whose severity is not yet visible, damage-control priorities, and the decision to call for an operation somebody else will do.

  Planned
• Critical care

  Reassess organ support over time and make each ventilator, circulation, and escalation change earn a measured response.

  Available

No dates are promised for planned modules. Watch the repository releases to hear when one ships. No email address is collected.