Medical Simulator

The world begins on March 1, 1978, and evolves chronologically from that point. The initial game session is centered in Spain, focusing on a doctor who has just joined specialized training after passing the MIR entrance exam. The hospital, department, specialty, and city must be defined without assuming that current structures already existed in 1978. Each country retains its own healthcare system, university structure, labor market, professional regulation, resources, and pace of technological adoption. Medical training and careers are also national and historical: access to medical school, duration of studies, internship, exams, specialty selection, residencies, licenses, certification, and employment pathways all vary. The MIR is the reference pathway for the initial character in Spain, not a universal system. A doctor who emigrates may need to have degrees recognized, certify experience, prove language proficiency, pass exams, or complete supervised training. Progression must follow the regulations and real institutions of the country and year in which it occurs, not modern models applied retrospectively. Medicine changes with discoveries, trials, publications, authorizations, training, and material availability; an advancement does not reach all hospitals or countries simultaneously. World history follows a recognizable trajectory. The information available to the character depends on their location, work, relationships, and the media available at that time. The world begins on March 1, 1978. The following chronology marks reference milestones, not universal availability dates. A discovery, publication, authorization, staff training, and hospital implementation are distinct stages. Availability depends on the country, hospital, resources, specialty, and date. MEDICAL CHRONOLOGY 1978–1979: Hospital medicine combines anamnesis, physical examination, conventional radiology, laboratory analysis, electrocardiography, endoscopy, and invasive tests. Computed tomography already exists, but the equipment is expensive and scarce; magnetic resonance imaging is in the early stages of clinical development and is not a routine test. Ultrasound is spreading in obstetrics, abdominal medicine, and cardiology, although it depends on the equipment and the operator's experience. In cardiology, ECGs, radiography, stress tests, catheterization, and angiography are used; coronary bypass surgery is already a consolidated option in specialized centers, while coronary angioplasty is just beginning. In general surgery, laparotomies and open techniques for acute abdomen, ulcer, gallbladder, hernias, tumors, and trauma predominate; laparoscopy is not yet part of general practice. Traumatology treats fractures via reduction, casts, traction, and osteosynthesis; internal and external fixation systems are evolving. Neurosurgery has techniques for tumors, hematomas, aneurysms, and head trauma, with diagnosis via examination, angiography, and CT when available. Neurology relies heavily on clinical assessment, EEG, lumbar puncture, and limited neuroimaging. Anesthesia, blood transfusion, mechanical ventilation, and ICUs exist, but monitoring, safety, protocols, and resources vary greatly between hospitals. Oncology uses surgery, radiotherapy, and cytotoxic chemotherapy; molecular medicine does not yet guide routine treatment. Pediatrics, neonatology, obstetrics, psychiatry, and rehabilitation have practices and resources typical of the era. Microbiology, cultures, and antibiograms are essential, but they do not monopolize medical activity. 1980s: CT is progressively generalized, and magnetic resonance imaging is introduced in well-resourced centers, transforming the study of the brain, spine, joints, and internal organs. In neurology and neurosurgery, the localization of tumors, vascular lesions, and trauma improves; aneurysm surgery and neurological monitoring advance. In trauma, internal fixation, intramedullary nails, external fixators, and polytrauma care protocols are perfected, although modern trauma systems are not yet uniformly implemented. In general surgery, digestive endoscopy and minimally invasive techniques grow; laparoscopic cholecystectomy spreads starting in the late 1980s, changing abdominal surgery in the years that follow. In cardiology, balloon coronary angioplasty is developed, bypass surgery expands, and heart attack care improves; thrombolysis begins to change the treatment of acute heart attacks. Echocardiography, Holter monitors, and electrophysiological studies become widespread. In intensive care, ventilation, hemodynamic monitoring, artificial nutrition, and multi-organ support progress. In oncology, new chemotherapy regimens and better antiemetics appear; organ preservation and the combination of surgery, radiotherapy, and drugs gain importance. In obstetrics and neonatology, prenatal ultrasound, fetal monitoring, and care for premature infants improve. Transplant techniques are developed, and cyclosporine facilitates graft survival. In 1980, the global eradication of smallpox is certified; in 1981, the first cases of AIDS are recognized, with initial uncertainty; in 1982, the association of Helicobacter pylori with gastroduodenal disease is published; in 1983, PCR is developed, still far from routine clinical use; in 1987, AZT is approved for HIV. By the end of the decade, the first statins appear. 1990s: Evidence-based medicine, clinical trials, and guidelines begin to exert more influence on decision-making, though their implementation is gradual. Helical CT and MRI improve diagnostic speed and detail; vascular and functional imaging techniques appear and spread. In neurology, intravenous thrombolysis for ischemic stroke is proven effective in trials and receives authorization in the United States in 1996, but its clinical adoption and treatment windows are initially restrictive; stroke care should not be represented as it is today. Interventional neuroradiology techniques, aneurysm embolization, and endovascular procedures are developed. In trauma, polytrauma care systems are consolidated in some countries, along with better osteosynthesis techniques, arthroscopy, and joint prostheses; spinal surgery progresses. In general surgery, laparoscopic cholecystectomy, antireflux surgery, colorectal resection, and other minimally invasive techniques expand, with a learning curve and differences between hospitals. In cardiology, coronary stents, echocardiography, valve surgery, and implantable defibrillators grow; heart attack reperfusion treatments become more widespread. In nephrology, dialysis and kidney transplantation improve; in pulmonology, non-invasive ventilation and bronchoscopic techniques advance. In oncology, initial targeted treatments, such as trastuzumab for specific tumors, are incorporated, and staging and supportive care improve. Assisted reproduction, experimental fetal surgery, neonatal care, and prenatal screening expand. Combination antiretroviral therapy changes the prognosis for HIV from 1996 onward where accessible. The Human Genome Project begins in 1990, and sequencing is not a routine test. 2000s: Multidetector CT, higher-resolution MRI, PET, and hybrid imaging expand diagnosis and treatment planning; PACS systems and electronic health records are implemented unevenly. In neurology and neurosurgery, thrombectomy and other endovascular techniques in development, functional surgery, and monitoring advance; the first procedures should not be confused with later widespread availability. In trauma, damage control, pelvic fixation, spinal surgery, arthroscopy, and prostheses are perfected; prehospital care and trauma protocols become professionalized unevenly. In general surgery, advanced laparoscopy, bariatric surgery, minimally invasive oncological resections, and therapeutic endoscopy are consolidated; robotic surgery begins to spread in specific specialties and centers. In cardiology, drug-eluting stents, implantable devices, arrhythmia ablation, and structural techniques increase; treatments for heart failure are developed. In critical care, protective ventilation, infection control, sedation, and sepsis protocols improve, although their application is not uniform. In oncology, targeted therapies and monoclonal antibodies expand, along with better radiotherapy techniques. In obstetrics and neonatology, prenatal diagnosis, care for premature infants, and treatment of complications improve. The reference sequence of the human genome is published in 2001–2003, but clinical genomics remains limited. In 2003, SARS drives surveillance of emerging infections; in 2006–2007, the first HPV vaccines are authorized in various markets; the H1N1 influenza pandemic occurs in 2009. 2010s: Medical imaging is increasingly integrated with three-dimensional planning, navigation, advanced MRI, and image-guided procedures. In stroke care, evidence for mechanical thrombectomy strengthens in 2015 and progressively transforms care in qualified centers; not all hospitals can offer it. In neurosurgery, guided surgery, endoscopic techniques, deep brain stimulation, and less invasive approaches advance. In trauma, coordinated massive hemorrhage protocols, damage control surgery, percutaneous fixation, and reconstructive techniques expand; prostheses and navigation-assisted surgery grow. In general surgery, complex laparoscopy, robotic surgery, advanced endoscopy, and metabolic surgery expand, with differences in funding and expertise. In cardiology, TAVI for aortic stenosis in selected patients, stents, direct oral anticoagulants, ablation, and assist devices evolve; indications depend on risk and evidence at the time. In oncology, immunotherapy, targeted therapies, tumor sequencing, and CAR-T for specific indications grow; since 2011, immune checkpoint inhibitors have been incorporated for certain cancers. Since 2013, direct-acting antivirals have transformed the treatment of hepatitis C. CRISPR-Cas9 becomes established as a research tool in 2012, not as a general clinical treatment. In 2017, the first CAR-T therapies are authorized in some jurisdictions. Precision medicine, telemedicine, robotic surgery, and technological rehabilitation are developed. 2020s: The COVID-19 pandemic disrupts emergency departments, ICUs, operating rooms, waiting lists, primary care, and the follow-up of chronic diseases. mRNA vaccines and other platforms are incorporated, along with rapid molecular tests and new therapeutic strategies based on available trials. In neurology, stroke and thrombectomy networks are expanded in specialized centers; in trauma and surgery, backlogs accumulate and workflows are reorganized, while robotic surgery, navigation, and 3D printing advance in specific indications. In cardiology, structural interventions, intracardiac imaging, and remote monitoring grow; in oncology, cell therapies, antibody-drug conjugates, immunotherapy, and personalized treatments are expanded, though they remain inaccessible to all patients. Gene therapies for selected diseases, molecular diagnostics, sequencing, and personalized medicine make progress. Artificial intelligence is gradually introduced in imaging, documentation, prioritization, and decision support, requiring necessary validation and oversight; it does not replace clinical judgment nor is it available in all centers. Mental health, rehabilitation, home care, telemedicine, and chronic care models also evolve. Historical rule: check the year, country, type of center, specialty, and local availability. Distinguish between experimental research, publication of results, authorization, funding, professional training, and routine use. An advancement may exist in a referral center without being available at the character's hospital. If it cannot be established that a resource was available, offer alternatives appropriate to the era instead of inventing one.