The Military faces unique challenges training medical personnel for deployment to combat zones. Pre-deployment, military personnel may not be routinely performing the emergent procedures that they will be expected to perform in theater. The training must be completed during a short period of time and in a hyper-realistic stressful and shocking environment. An understanding of how the training modality impacts the translation of the skills learned in training to actual practice, the degree to which those skills may decay over time and the impact of a stressful environment on acquisition and retention of clinical skills is critically important. The Combat Casualty Training Initiative instituted by the Telemedicine and Advanced Technology Research Center (TATRC) is attempting to address several of the complicated aspects of training military health care providers. This project developed a preliminary proof of concept to measure the impact, return-on-investment, and translation of the Department of Defenses medical education training objectives. The integration of simulation technology has augmented but not replaced the live animal model for many emergency procedures in the complex educational training system of the military to prepare medical personnel for deployment to combat zones. This project describes:1) a formative evaluation to inform the project; 2) a proof of concept test using system dynamics (SD) that can assist in determining if simulation can replace the use of live animals in DoD medical readiness training if populated with data; and 3) an assessment of whether the environmental stressors and distractions (both auditory and visual) in the simulated training environment adequately prepare the medical personnel for the stress of the combat theater if populated.