AMORPHOUSFor coherent behavior from vast numbers of unreliable microsensors, actuators, and communication devices interconnected in unknown ways, apply the lessons of cellular cooperation in biological organisms.O ver the next few decades, two emerging technologies-microfabrication and cellular engineering-will make it possible to assemble systems incorporating myriads of informationprocessing units at almost no cost, provided all units need not work correctly and that there is no need to manufacture precise geometrical arrangements among them. The shift to this technology will precipitate fundamental changes in methods for constructing and programming computers, and in our view computation itself Microelectronic mechanical components have become so inexpensive to manufacture we can anticipate integrating logic circuits, microsensors, actuators, and communications devices on the same chip to produce particles that could be mixed with bulk materials, such as paints, gels, and concrete. Imagine coating bridges and buildings with smart paint that senses and reports on traffic and wind loads and monitors structural integrity. A smart-paint coating on a wall could sense vibrations, monitor the premises for intruders, and cancel noise.Even more striking is the amazing progress in understanding the biochemical mechanisms in individual cells, promising that we'll be able to harness these mechanisms to construct digital logic circuits.^

Overall performance in component tasks and complete cardiac surgical procedures improved during simulation-based training. Simulation-based training imparts skill sets for management of adverse events and can help produce safer surgeons.

The cardiac surgical simulation preparation described here would appear to be able to contribute positively to the training of residents in low-volume centres, as well as having the potential for application in other settings as a training tool or clinical skills assessment or accreditation device. Collaboration with larger centres is recommended in order to accurately assess the utility of this preparation as an adjunctive cardiothoracic surgical training aid.

The Cardiac Surgery Simulation Curriculum was implemented with robust adoption among the investigating centers. Both residents and faculty viewed the modules favorably. Using this curriculum, participants indicated an improvement in resident technical skills and were enthusiastic about training in adverse events and crisis management.

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