Background: Simulation suddenly came into the limelight of regulation a few years ago when the Accreditation Council on Graduate Medical Education (ACGME) recommended simulation training without specifics. That left internal medicine program directors confused as they tried to figure out what was best for their residents. Summary: The author’s review discusses the many issues and unanswered questions regarding simulation training. It appears clear to this faculty member that residents enjoy the additional training to make them more comfortable doing procedures related to their training. A few studies mention longevity in retention of skills learned over time and very few discuss the numbers of procedures to attain competency and outcome improvements if they occur. Conclusion: This leaves several areas that need further study on the effects of simulation training in residency and meeting the needs of post-graduate descriptions via surveys following training. What kind of procedures and clinical scenarios (codes, medical dilemmas, ethical/communication issues), how often/how many, timing and appropriate measurements especially if focusing on improved patient outcomes. This narrative summary utilized a review focusing on simulation, internal medicine and various simulation outcomes.